CLASS C

ANNEX B

Name: Unit:

Assumption Date: _______________________

Please tick one.

_______ 1. I am employed for CY 2019 before joining LANDBANK and I was informed
that it is a must to submit BIR 2316 for CY 2019. (Please fill out the CERTIFICATION
below.)

_______ 2. I am not employed for CY 2019 before joining LANDBANK so there is no

need for me to submit BIR Form 2316 CY 2019. (Affix your signature here.)
_________________

_______ 3. I recently graduated before joining LANDBANK so there is no need to for me

to submit BIR 2316 CY 2019. (Affix your signature here.) _________________

CERTIFICATION

This is to certify that I, _________________________________, whose my last

employment was from ___________________ to ___________________ at
__________________________________.

In compliance with the BIR Regulation No. 2-98, I hereby acknowledge that I am
required to submit the BIR Form 2316 from my previous employer to my present
employer, LBP. However, due to the cut-off of receiving said form on October 31, 2019
per memo dated October 7, 2019, I will be in charge of the consolidation/annualization of
my income tax CY 2019.

Thus, whatever consequences to be incurred will be shouldered by me for the non-

submission of the same.

This certification is issued for payroll/taxation only.

____________________________
Signature over printed name

Date signed: _________________

Note: If hired from November to December 2019.