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Annex A

PRINTERS CERTIFICATE OF DELIVERY OF RECEIPTS AND/OR INVOICE


I, ______________________________________ , Proprietor/Owner/President or Duly-Authorized Representative of ( Name of Printer ), a Single Proprietor/Corporation/Partnership duly registered and existing under the laws of the Philippines, with principal office at ____________________, hereafter referred as the Printer, hereby certifies the following: 1. That (Name of Taxpayer) follows: engaged my/our services to print his/its Receipts/Invoices, details of which are as

Required Data TIN Name Registered Address Home RDO

Printers Details

Taxpayers Details

(A) Category of Document

Invoice

Official Receipt

Others (specify) ________________

(B) Details of Receipts/Invoices covered by this delivery:


Doc Type Bound Loose Kind of OR/Invoice
e.g. VAT or Non-VAT e.g. VAT or Non-VAT

Category Sales Invoice Official Receipt

ATP Number 00000 00000

No. of Booklets 1,000 500

No. of Sets per Booklet 50 50

No. of Copies Per set 3 2

Inclusive Serial Numbers 0001 - 1000 0001 - 0500

Place where the Invoice /Receipts will be used

(C) Mode of delivery (D) Size of Receipts/Invoice

___________

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

: : : : :

_____ Bound______ xxxx xxxx ______xxxx_______ xxxx ===============

___ Looseleaf_____ xxxx _____xxxx_______ _____xxxx_______ xxxx ===============

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
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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.

Name of Printer Address TIN

______________________________ ______________________________ ______________________________

By: ___________________________________________ Signature Over Printed Name Authorized Representative

Position: TIN

______________________________ ______________________________

Note:

The PCD shall cover receipts and invoices embodied in just one ATP

Annex A Page 2

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