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    Annex C RR 11-2018

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    Rheneir Mora
    This document is an income payor's sworn declaration containing the following information in 5 points: 1. The number of income payees with no tax withholding, broken down by type of withholding. 2. These payees have submitted sworn declarations of their expected gross receipts. 3. The number of individual and non-individual payees subject to a 5% withholding tax rate due to expected gross receipts below thresholds. 4. Lists of payees from points 1 and 3 are attached. 5. The declaration complies with requirements of Revenue Regulations No. [SECTION NUMBER].

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    Annex C RR 11-2018

    Uploaded by

    Rheneir Mora
    903 views1 page
    This document is an income payor's sworn declaration containing the following information in 5 points: 1. The number of income payees with no tax withholding, broken down by type of withholding. 2. These payees have submitted sworn declarations of their expected gross receipts. 3. The number of individual and non-individual payees subject to a 5% withholding tax rate due to expected gross receipts below thresholds. 4. Lists of payees from points 1 and 3 are attached. 5. The declaration complies with requirements of Revenue Regulations No. [SECTION NUMBER].

    Original Description:

    Annex C

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    This document is an income payor's sworn declaration containing the following information in 5 points: 1. The number of income payees with no tax withholding, broken down by type of withholding. 2. These payees have submitted sworn declarations of their expected gross receipts. 3. The number of individual and non-individual payees subject to a 5% withholding tax rate due to expected gross receipts below thresholds. 4. Lists of payees from points 1 and 3 are attached. 5. The declaration complies with requirements of Revenue Regulations No. [SECTION NUMBER].

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    903 views1 page

    Annex C RR 11-2018

    Uploaded by

    Rheneir Mora
    This document is an income payor's sworn declaration containing the following information in 5 points: 1. The number of income payees with no tax withholding, broken down by type of withholding. 2. These payees have submitted sworn declarations of their expected gross receipts. 3. The number of individual and non-individual payees subject to a 5% withholding tax rate due to expected gross receipts below thresholds. 4. Lists of payees from points 1 and 3 are attached. 5. The declaration complies with requirements of Revenue Regulations No. [SECTION NUMBER].

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    of 1

    Annex “C”

    INCOME PAYOR/WITHHOLDING AGENT’S SWORN DECLARATION

    I, _________________________________________________, ____________________________, of legal age, single/


    (Name of Proprietor/Authorized Officer) (Citizenship)
    married, the designated _______________________________________ of _________________________________
    (Designation/Position) (Name of Withholding Agent)
    with Taxpayer Identification Number (TIN) _________________________________ _, after having been duly sworn in

    accordance with law hereby depose and state:

    1. That there are ____________ income payees (self-employed individuals) where no withholding is made, consisting of
    the following:

    Type of withholding NOT withheld Number of income payees


    Expanded WT only
    WT on VAT/Percentage Tax only
    Both expanded and VAT/Percentage tax
    Total

    2. That the above payees where no withholding tax is deducted from their income payment/s have executed the required
    Income Payee’s Sworn Declarations on the amount of gross receipts which they expect to receive for the year
    ______________, and these sworn declarations are duly received together with copies of their Certificate of
    Registration (COR);

    3. That there are _________ individual income payees withheld five percent (5%) withholding tax rate due to their
    submission of “Payee’s Sworn Declaration of Gross Receipts/Sales” stating that their gross receipts/sales shall not
    exceed ₱3,000,000 (₱3M) for the current year, while ______ non-individual payees submitted “Income Payee’s Sworn
    Declaration” stating that their gross receipts/sales shall not exceed P720,000 for the current year;

    4. That I am attaching with this sworn declaration the list of individual payees subject of items 1 and 2 above consisting
    of ________ number of pagers, the list of individual payees subject of item 3 above with ____________ number of
    pages, and the list of non-individual payees subject also of item 3 above with _________ number of pages;

    5. That the submission is in compliance with the requirements prescribed under Section _________ of Revenue
    Regulations No. ___________.

    6. That this declaration, including the attached list/s, is made in good faith, to the best of my knowledge and belief, to be
    true and correct, under the penalties of perjury.

    IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________, 20___ at ___________, Philippines

    __________________________________________________
    Signature over Printed Name of Withholding Agent/Authorized Officer of the Withholding
    Agent

    __________________________________________________
    Designation/Position if Authorized Officer

    __________________________________________________
    Name of Withholding Agent/Lone Payor

    SUBSCRIBED AND SWORN to before me this _____ day of ____________, 20___ in


    _______________________________. Applicant exhibited to me his/her ___________________________issued at
    _______________________ on _________________________.
    (Government Issued ID and No.)

    NOTARY PUBLIC
    Doc. No.: __________
    Page No.: __________
    Book No.: __________
    Series of ___________

    Affix ₱30.00
    Documentary
    Stamp Tax

    (To be filled-out by the concerned Revenue Officer)

    Date Received: __________________ Received by:


    (MM-DD-YYYY-00001)
    __________________________________________________________
    Signature over Printed Name of Revenue Officer

    __________________________________________________________
    Designation/Position of Revenue Officer
    __________________________________________________________
    RDO No.

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