2551Q
2551Q
2551Q
PSIC:
(For transactions involving overseas dispatch, message, or conversation originating from the Philippines and Amusement Taxes )
2551Q
February 2002 (ENCS) Number of sheets attached
Part I 6 9 TIN
Information
8 Line of Business/ Occupation Taxpayer's Name (For Individual)Last Name, First Name, Middle Name/(For Non-individual) Registered Name
10
Telephone Number
11 Registered Address
12
Zip Code
13 Are you availing of tax relief under Special Law or International Tax Treaty? Part II Taxable Transaction/ Industry Classification 14A 15A 16A 17A 18A 19 Total Tax Due 20 Less: Tax Credits/Payments 20A 20B 21 Creditable Percentage Tax Withheld Per BIR Form No. 2307 Tax Paid in Return Previously Filed, if this is an Amended Return 20A 20B 21 22 Interest 23C Compromise
23D
Yes
Tax Rate
Tax Due
22 Tax Payable (Overpayment) (Item 19 less Item 21) 23 Add: Penalties Surcharge 23A 23B
24 24 Total Amount Payable/(Overpayment) (Sum of Items 22 and 23D) If overpayment, mark one box only: To be Refunded To be issued a Tax Credit Certificate I declare, under the penalties of perjury, that this return has been made in good faith, verified by me, and to the best of my knowledge, and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. 25 26 Title/Position of Signatory Signature over Printed Name of Taxpayer/ Taxpayer Authorized Representative TIN of Tax Agent (if applicable) Part III Drawee Bank/ Particulars 27 Cash/Bank Debit Memo 28 Check 28A 29 Tax Debit Memo 30 Others 30A
30B 30C 30D 28B 29A 28C 29B
Tax Agent Accreditation No. (if applicable) Stamp of Date Receiving Office YYYY
27 28D 29C
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
evn
ATC
Overseas dispatch, message or conversation originating from the Philippines Cockpits Cabarets, day or night clubs