"Annex B"

NAME OF TAXPAYER
Monthly Summary of Cosmetic Procedures Performed
For the Month _______________

OFFICIAL RECEIPT COSMETIC PROCEDURES PERFORMED GROSS RECEIPTS

Non-Invasive Invasive Non-Invasive Invasive
5% Excise Tax to be remitted
Excisable (Net of Non-excisable (Net of (E)
No. Date Net of VAT Vat & Excise) Excisable (VAT exempt) VAT)
Exempt Excisable Non-excisable Remarks

(A) (B) (C) (D) (E = B x 5%) + (E = C x 5%)

Illustration 1:
1001 1/1/2018 liposuction 42,517.01 2,125.85

Illustration 2:
1001 1/1/2018 liposuction 44,642.86 20,000.00 3,232.14