CHECKLIST OF REQUIREMENTS IN THE ACCREDITATION OF

PRINTERS

INFORMATION

NAME OF PRINTER: IMPRENTA DESIGN AND PRINTS

Registered/Business Address: 05540 Bagong Silang 1, Washington Pob, Surigao City

Taxpayer Identification Number: 328-841-865-000 RDO: Bureau of Internal Revenue

District 105 Surigao City
CHECKLIST
Mark “X” if included in documents presented.

SWORN STATEMENT pursuant to RR 15-2012

Mayor’s Permit, Current Year (if applicable)

Certification of No Tax Delinquency issued by RDO/LT office where the applicant is registered

Company/Organization Profile
 Organization Chart;
 List of Officials/Board of Directors/Owners;
 List of personnel employed (including the employment status) in printing of ORs/Sis;
 List of printing machines (with serial numbers) to be used specifically for printing of ORs/Sis.

Complete Description and sample of security/special markings/features in the printing of the principal
and supplementary invoices/receipts

Certificate of Registration of Business Name issued by the Department of Trade of Industry (DTI), in
case the Business Trade Name shall be used by self-employed individuals

Agency’s/Unit’s Charter, for government printers

Certificate of registration and Articles of Incorporation issued and approved by the Securities and Exchange Commission
(SEC), in case of corporation and partnership

On-site inspection Checklist for Accreditation of Printers- For BIR only (to check printing machines and security features of
official receipts/sales invoices)
 ANNEX “A”

SWORN STATEMENT

REPUBLIC OF THE PHILIPPINES

PROVINCIAL OF SURIGAO DEL NORTE
CITY/MUNICIPALITY OF SURIGAO CITY

I Ofelia A. Cuadrillero, Filipino, of legal age designated as owner of Imprenta Design and Prints, with
registered address located at 05540 Bagong Silang 1, Washington Pob, Surigao City do hereby certify the following:

 THAT, Imprenta Design and Prints, with business address at 05540 Bagong Silang 1, Washington Pob,
Surigao City is a duly registered entity under the laws of the Philippines;

 THAT the company is engaged in Printing Services and existing under Imprenta Design and Prints with TIN 328-841-
865-000 and has been operation for no less than three (3) years in printing the principal and supplementary
invoices/receipts:

 THAT the company owns Reso Machine, Cutter, Computer/Printer for printing of the principal and supplementary
invoices/receipts.

 THAT the company’s printing machines are capable of generating security features/ markings in printing of the
principal and supplementary invoices/receipts:

 THAT the company shall only print customer’s or client’s principal and supplementary invoices/receipts with an
Authority to Print secured from the BIR:

 THAT the company shall not require a minimum number of booklets for printing for its customers/clients:

 THAT the aforementioned principal and supplementary invoices/receipts to be printed are serially numbered and
conformed to the requirements of Section 237, 238 and 113 (for VAT-registered taxpayers) of the National Internal
Revenue Code of 1997, as amended and other prevailing rules and regulations:

 THAT the company will comply with the provisions of the bookkeeping regulations and reportorial requirements of the
BIR:

 THAT the company, or the owner, is not connected with the BIR or is not related to any BIR official or employee
within the fourth civil degree of consanguinity or affinity or the latter’s relatives within the fourth civil degree of
consanguinity or affinity.

 THAT in the event that the foregoing be discovered to be violation of existing rules and regulations, I hereby undertake
to face any legal sanctions and pay corresponding penalties thereof as provided for under the National Internal Revenue
Code of 1997, as amended.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING

ATTESTATIONS ARE TRUE AND CORRECT.
OFELIA A. CUADRILLERO
Name and Signature of Affiant/
Authorized Representation
TIN: 328-841-865-000

SUBSCRIBED and sworn to before me, in the City/Municipality of Surigao City, this day of
, 20 by with Residence Certificate No. issued at , on,

20 .

Notary Public
Doc. No.
Page No.
Book No.
 Series of
Republic of the Philippines
Department of Finance ANNEX
BUREAU OF INTERNAL REVENUE “A”
Revenue District Office No. 105

TCVS NO. 105-10-17-N00008-2018

TAX COMPLIANCE VERIFICATION SHEET

TIN: 928-841-865-000 BRANCH CODE: 000 RDO: 105 DATE OF REGISTRATION: January 31, 1996
NAME OF TAXPAYER: OFELIA A. CUADRILLERO
TRADE NAME: IMPRENTA DESIGN AND PRINTS
REGISTERED ADDRESS: 05540 BAGONG SILANG 1, WASHINGTON POB., SURIGAO CITY

CLIENTS SUPPORT SECTION/TAXPAYER COMPLIANCE

Verified by: REMARKS
SECTION

NOT-
COMPLIANT
CAMPLIANT

Annual Registration Fee DELIA N. LERIN

Chief, Clients Support Section
No open valid “Stop-filler”
DELIA N. LERIN
cases Chief, Clients Support Section
Users of Electronic Filing and
DELIA N. LERIN
Payment System (EFPS) Chief, Clients Support Section
Not tagged as “Cannot Be
DELIA N. LERIN
Located” taxpayer Chief, Clients Support Section

COLLECTION SECTION DELIA N. LERIN

Chief, Clients Support Section
No record of Accounts
Receivable/Delinquent EDNA LINA REYNA
Accounts Acctg. Chief, Collection Section

APPROVED BY:
New: REQUEST OF CERTIFICATION OF NO TAX DELINQUENCY

, 2020

MR. LORDEL T. MONTECLARO

Revenue District Officer
Bureau of Internal Revenue
District 105
Surigao City

Mr. Monteclaro;

Good Day!

I would like to request from your good office a Certification of No Tax Delinquency for the
requirements in the Accreditation of Printers for Imprenta Design and Prints.

I am anticipating for your assistance in this matter. Thank you.

OFELIA A. CUADRILLERO
Owner
OWNER: OFELIA A. CUADRILLERO

LIST OF MACHINES:

1. Reso Machine -
2. Cutter Machine -
3. Computer/Printer -

LIST OF PERSONNEL EMPLOYED:

1.
2.
3.
4.
5.
 ORGANIZATIONAL CHART
IMPRENTA DESIGN AND PRINTS

OWNER

COMPUTER
OPERATOR

PRINTER MACHINE
NUMBERING
OPERATOR

BINDER

CUTTER