Emj 0605
Emj 0605
Emj 0605
DLN:
PSIC:
PSOC:
BIR Form No.
Republika ng Pilipinas
Kagawaran ng Pananalapi
0605
Payment Form
Fill in all applicable spaces. Mark all appropriate boxes with an "X"
1
2
7
For the
Calendar
Fiscal
Year Ended
12
2014
( MM / YYYY )
Return Period ( MM / DD / YYYY )
Quarter
5 No. of Sheets
ATC
Attached
1st
8
2nd
3rd
4th
BCS No./Item No. (To be filled up by the BIR)
RF
Part I
9
Background
409
13
246
Taxpayer's
Information
10 RDO Code
333
11 Taxpayer Classification
23B
12 Line of Business/Occupation
DRUGSTORE
14 Telephone Number
Name
(Last Name, First Name, Middle Name for Individuals) / (Registered Name for Non-Individuals)
15 Registered
Address
16 Zip Code
Self-Assessment
Tax Deposit/Advance Payment
21
Installment
No. of Installment
Partial
Payment
(Individual)
Full
Others (Specify)
Payment
Part II
19
20
18 Type of Payment
3100
Computation of Tax
19
Interest
Compromise
20C
20D
21
MARGARITA C. MENDOZA
OWNER
Part III
500
I declare, under the penalties of perjury, that this document 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.
22A
500
22B
Title/Position of Signatory
D e t a i l s of P a y m e n t
Particulars
Drawee Bank/Agency
Number
MM
23 Cash/Bank
DD
YYYY
Amount
23
Debit Memo
24A
24B
17C
24C
24D
25B
25C
24 Check
25 Tax Debit
25A
500
Stamp of Receiving
Office
and Date of Receipt
Memo
26A
26B
19C
26C
26 Others
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
Taxpayer Classification:
I - Individual
N - Non-Individual
26D
NATURE OF PAYMENT
II 011
II 012
II 013
MC 180
MC 190
MC 090
MC010 & MC020
MC 040
MC 050
MC 060
MC 031
MC 030
FP 010 - FP 930
MC 200
XA010-XA040
XA061-XA090
XA051-XA053
ATC
NATURE OF PAYMENT
Code
RF
TR
ET
QP
MC
XV
XS
XF
IT
CG
Description
REGISTRATION FEE
TRAVEL TAX-PTA
ENERGY TAX
QUALIFYING FEES-PAGCOR
MISCELLANEOUS TAX
EXCISE-AD VALOREM
EXCISE-SPECIFIC
TOBACCO INSPECTION AND
MONITORING FEES
INCOME TAX
CAPITAL GAINS TAX - Real Property
Code
CS
ES
DN
VT
PT
ST
SO
SL
DS
WB
ATC
Tobacco Products
Smoking and Chewing Tobacco
Cigars
Cigarettes Packed By Hand
Cigarettes Packed By Machine
Tobacco Inspection Fees
Cigars
Cigarettes
Leaf Tobacco & Other Manufactured Tobacco
Monitoring Fees
Petroleum Products
Premium (Leaded) Gasoline
Premium (Unleaded) Gasoline
Regular Gasoline
Naptha & Other Similar Products
Aviation Gasoline
Diesel Gas
Bunker Fuel Oil
NATURE OF PAYMENT
XP120
XP130 & XP131
XP170
XP150 & XP160
XP010, XP020 &
XP190
XP040
XP030
XG020-XG090
XG100-XG120
XM010
XM020
XM030
XM040
XM050
XM051
TYPE
Description
CAPITAL GAINS TAX - Stocks
ESTATE TAX
DONOR'S TAX
VALUE-ADDED TAX
PERCENTAGE TAX
PERCENTAGE TAX - STOCKS
PERCENTAGE TAX - STOCKS (IPO)
PERCENTAGE TAX - SPECIAL LAWS
DOCUMENTARY STAMP TAX
WITHHOLDING TAX-BANKS AND OTHER
FINANCIAL INSTITUTIONS
Code
WC
WE
WF
WG
WO
WR
WW
Description
WITHHOLDING TAX-COMPENSATION
WITHHOLDING TAX-EXPANDED
WITHHOLDING TAX-FINAL
WITHHOLDING TAX - VAT AND OTHER
PERCENTAGE TAXES
WITHHOLDING TAX-OTHERS (ONE-TIME TRANSACTION NOT SUBJECT TO CAPITAL
GAINS TAX)
WITHHOLDING TAX - FRINGE BENEFITS
WITHHOLDING TAX - PERCENTAGE TAX
ON WINNING AND PRIZES
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