Republika ng Pilipinas

Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
BIR Form No
2 3 0 6
March 2003 (ENCS

1 For the Period From: To
Part I Income Recipient/Payee Information
TIN 3 TIN
4 Payee's Name (For Non-Individuals)
5 Payor's Name (For non-individuals)
6 Payee's Name (Last Name, First Name, Middle Name) for Individuals 7 Payor's Name (Last Name, First Name, Middle Name) for Individuals
8 Registered Address: 9 Registered Address
8A Zip Code 9A Zip Code:
23206 10B ICR (For Alien Income Recipient Only)
10A Zip Code:
Part II D e t a i l s o f I n c o m e P a y m e n t s a n d T a x W i t h h e l d
Nature of Income Payment ATC Amount of Payment Tax Withheld

TOTAL - -
We declare under the penalties of perjury, that this certificate has been made in good faith, verified by us, and to the best of our 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.

11 Date Signed: ____________________
Payor/Payor's Authorized Representative
(Signature Over Printed Name)
CONFORME:
12 ____________________________ Date Signed: ______________________
Payee/Payees'Authorized Representative
(Signature Over Printed Name)
I declare under the penalties of perjury
that the information herein stated are
reported under BIR Form No. 1600 which
have been filed with the Bureau of the
Internal Revenue.
the Bureau of Internal Revenue.

13
______________________________ 14 ________________________________
Payor/Payor's Authorized Representative Payee/Payees' Authorized Representative
Signature Over Printed Name Signature Over Printed Name
Certificate of Final Tax
Withheld at Source
To be accomplished for Value-Added Tax/Percentage Tax Withholding (substituted filing)
I declare under the penalties of perjury that I am qualified under substituted filing of
Percentage Tax/Value Added Tax Return (BIR Form 2551M/2550M/O, since I have only one
payor from whom I earn my income; that, in accordance with RR 14-2003, I have availed of
the Optional Registration under the 3% Final Percentage Tax Withholding/10% Final VAT
Withholding in lieu of the 3% Percentage Tax/10% VAT in order to be entitled to the privileges
accorded by the Substituted Percentage Tax Return/Substituted VAT Return System prescribed
in the aforesaid Regulations; that, this Declaration is sufficient authority of the withholding
agent to withhold 3% Final Percentage Tax/10% Final VAT from my sale of goods and/or
services.
Withholding Agent/Payor Information




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