BOI FORM S-1

ANNUAL REPORT ON ACTUAL OPERATIONS

For Calendar Year Ending For Fiscal Year Ending

To be filled out by LCS evaluator:

Date Submitted: PSIC Code:

Guidelines :
1 Deadline of submission for this report shall be as follows:
For Calendar Year - 30th of April
For Fiscal Year - Four (4) months after the end of fiscal year

2 The information provided in this report shall be accurate and precise and reflect the real data pertaining to the enterprise and its
registered project.
3 This report shall be submitted both in soft (Excel format) and hard copies. Only one hard copy is required for submission, which
should be notarized and signed by the enterprise's authorized signatory.
4 The enterprise shall submit one report for each registered project.

5 The Audited Financial Statements and Income Tax Return, duly stamped by the Bureau of Internal Revenue, should be submitted
in scanned copy saved in a CD.

I. BASIC INFORMATION

COMPANY DETAILS
Name of Enterprise:
Office Address Street No. / Brgy: City / Municipality:
Province: Region:
Telephone No.: E-mail: Fax No.:
Plant Address Street No. / Brgy: City / Municipality:
Province: Region:
Telephone No.: Fax No.:
VAT/TIN No.: Date:
Representative to BOI: Position:
Telephone No.: Mobile: Fax: Email:

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II. COMPANY PERFORMANCE FOR THE YEAR

Current Assets
Non-Current Assets
Property, Plant and Equipment
Stock Investments
Total Assets ₱ -

Foreign Loans
Total Liabilities

Retained Earnings
Retained Earnings intended for reinvestment
Additional Paid-In
Total Stockholders' Equity

Debt-Equity Ratio #DIV/0!

EQUITY PROFILE
Authorized Capital (P):
Equity by Nationality Percentage (%) Subscribed (P) Paid-up (P)
Filipino
Foreign
(pls. indicate nationality)
Major Stockholders
Name Nationality Percentage (%) Subcribed (P) Paid-Up (P)

Gross Income
Training expense
Research and Development expense
Logistics Expense
Rental Expense under Capital Expenditure
Total Expense
Taxable Income
NOLCO (if applicable)

TAXES PAID FOR THE YEAR

Total taxes paid other than income tax during ITH period
documentary stamps
withholding taxes on employees' salaries and
wages
annual registration
real estate taxes
business taxes/permits
occupation taxes
taxes on importation
Total taxes paid after ITH entitlement period
Taxes paid on importation (raw materials, supplies, and capital equipment)
Total VAT paid
Total VAT Paid for Raw Materials

DUTIES PAID FOR THE YEAR

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Major Stockholder
Name Nationality Percentage (%) Subcribe (P) Paid-Up (P)

LCS-CSD-FORM-MR-S1Updated as of 25 April 2017

III. BOI - REGISTERED PROJECT PROFILE

Registration No. / Date

Registered Activity
Registered Capacity
Governing IPP
Export Commitment (if applicable)
Date of Actual Start of Commercial Operation
Actual Start of Commercial Operation (for RE projects) Applicable Not applicable
Date:
Certification No.
Pre-Operating
Operating
Status of Operation
Stopped Operation
Date:

Project Cost (per STC)

Actual Investment Cost (for the year)
Actual Aggregate Investment Cost (from date of registration)

Expenses for Infrastructure Works

Environmental Compliance Certificate / Certificate of Non-Coverage Applicable Not applicable

Not yet submitted
Submitted/Date:
Tree Planting (please indicate type of trees and location) Applicable Not applicable
Total Number of Trees Planted Not yet submitted
Submitted/Date:
Corporate Social Responsibility (please indicate) Applicable Not applicable
Not yet submitted
Submitted/Date:
Certification based on internationally recognized standards (please indicate Applicable Not applicable
type of certificate) Not yet submitted
Submitted/Date:
Certification of Compliance (for power projects) Applicable Not applicable
Not yet submitted
Submitted/Date:
License to Operate/Food and Drugs Administration (FDA) Certification (if Applicable Not applicable
applicable) Not yet submitted
Submitted/Date:
Undertaking that the incentives availed shall translate to the benefit of the Applicable Not applicable
end-users (if applicable) Not yet submitted
Submitted/Date:
Proof of Financial Close (if applicable) Applicable Not applicable
Not yet submitted
Submitted/Date:
Certificate of Good Standing from Mines and Geosciences Bureau (for mining Applicable Not applicable
projects) Not yet submitted
Submitted/Date:
Self-accomplished good governance scorecard Applicable Not applicable
Not yet submitted
Submitted/Date:

Reportorial Requirements:
AFS (Date submitted)
ITR (Date submitted)

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IV. LABOR GENERATION AND FOREIGN EXCHANGE INFLOWS AND OUTFLOWS FOR THE YEAR

A. LABOR GENERATION

Annual
No. of personnel hired Aggregate Payroll/Expense of the
number of
for the year employees aggregate number of
employees

Filipino Management
Administrative/Sales
Direct Labor
Indirect Labor
Outsourced Labor
Expatriate
(specify
position &
nationalit
y)
Total Labor Expense -

B. EXCHANGE INFLOWS AND OUTFLOWS (if applicable)

Applicable Not applicable
Foreign Exchange Inflows Currency Value
Export Earnings
Foreign Exchange Outflows
Acquisition of Equipment
Purchase of Spare parts
Purchase of Raw Materials and Supplies
Remittances
Others

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V. PRODUCTION AND PERFORMANCE DATA FOR THE REGISTERED PROJECT FOR THE YEAR

A. NET VALUE ADDED

B. PERFORMANCE DATA
Total Production Value Unit of Measurement
Volume
Cost
Total Sales
Domestic Sales
Volume
Value
Export Sales
Direct
Volume
Value
Value (Other Currency)
Indirect
Volume
Value
Value (Other Currency)
Constructive
Volume
Value
Value (Other Currency)

Export Market

C. COST OF SALES Applicable Not applicable

Cost of Goods Manufactured/Sold (engaged in manufacturing)
Cost of Raw Materials sourced from micro and small
enterprises (if applicable)
Cost of Raw Materials locally sourced

D. COST OF SERVICE Applicable Not applicable

Cost of Service (engaged in trading/other services)
Cost of service sourced from micro and small enterprises (if
applicable)

E. NET PROFIT FROM REGISTERED PROJECT

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VI. COMPLIANCE FOR MASS HOUSING PROJECTS
Applicable Not applicable

A. Profile of Horizontal/Vertical Project

HLURB Certificate of Registration No./Date
License to Sell No./Date

B. Compliance on 20% Socialized Housing Requirement (SHR)

1. Name of Socialized Housing Project
2. Project Location Street No./Brgy: City/ Municipality:
Province: Region:
3. Approach Applied 20% of Land Area
20% of Project Cost
Investment Scheme (20% of saleable area)
Direct Participation
30% of 20% of Building Construction Cost
40% of Income Tax Holiday Incentive Claimed
€
4. Status of Completion
a. Required 20% SHR Compliance (unit)
b. No. of actual units constructed
c. Size per unit ( sq. m.)
d. Construction cost per unit
e. Percentage of completion to date (b/a) #DIV/0!
5. Proof of Compliance
HLURB Certificate of Registration No. Applicable Not applicable
Not yet submitted
Submitted/Date:
License to Sell No. Applicable Not applicable
Not yet submitted
Submitted/Date:
Engineer’s Affidavit Applicable Not applicable
Not yet submitted
Submitted/Date:
Project Development Plan Applicable Not applicable
Not yet submitted
Submitted/Date:
Development Permit Applicable Not applicable
Not yet submitted
Submitted/Date:
Verified Survey Return Applicable Not applicable
Not yet submitted
Submitted/Date:
Memorandum of Agreement with LGU or Developer’s Applicable Not applicable
Not yet submitted
Submitted/Date:
Subsidiary (indicating amount of firm’s participation) Applicable Not applicable
Not yet submitted
Submitted/Date:
Philippine Contractors Accreditation Board (PCAB) Applicable Not applicable
License Not yet submitted
Submitted/Date:
Memorandum of Agreement with Accredited NGO’s Applicable Not applicable
Not yet submitted
Submitted/Date:
Certificate of Donation Applicable Not applicable
Not yet submitted
Submitted/Date:
Amount: Official Receipt No.
Others (Please specify) Applicable Not applicable

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 CERTIFICATION

I, ,of legal age, (status), with address at

after having been sworn in accordance with law, hereby state that:

1. I am occupying the position of in

with business address at

2. I have caused the preparation of the annual report on actual operations.

3. I have read and understood the contents thereof and that all information therein
are true and correct.

Done in on .

Name/Signature

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