72rr03 26anxa
72rr03 26anxa
72rr03 26anxa
Printers Details
Taxpayers Details
Invoice
Official Receipt
___________
Partial Delivery
_______
Full Delivery
(E) Details of Delivery: Total No. of Booklets/Looseleaf to be Printed Less: No. of Booklets/Looseleaf delivered Previous Delivery This/Current Delivery Outstanding Balance
: : : : :
2.
That upon issuance of the authority to print (ATP) by the BIR-RDO No. _______________on ___________________ under OCN/ATP No. _____________________________, the aforesaid receipts and invoices were printed. Photocopy of aforementioned ATP is hereto attached. That copies of the aforementioned receipts/invoices have been delivered to the above-named taxpayer; That no other copies of aforementioned receipts/invoices have been printed or reproduced except the copies delivered to the taxpayer as mentioned in the preceding statement; and
Page 1
3. 4.
5.
That the printer shall not print or reproduce nor shall it permit its machines or facilities to be used to print or reproduce extra or additional copies of the receipts/invoices above-described. in compliance with BIR Regulations
This certification is issued to ________( Name of Taxpayer)_________ No. _________ and for all legal intents and purposes this may serve.
Done this _________ day of __________________ at ____________________________. I declare under the penalties of perjury that this certificate 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.
Position: TIN
______________________________ ______________________________
Note:
The PCD shall cover receipts and invoices embodied in just one ATP
Annex A Page 2