Attachment to BIR Form 1601-EQ

QUARTERLY ALPHABETICAL LIST OF PAYEES SUBJECTED TO EXPANDED WITHHOLDING TAX & PAYEES WHOSE INCOME PAYMENTS A
FOR THE QUARTER ENDING SEPTEMBER, 2019

TIN : 203139533-0000
WITHHOLDING AGENT'S NAME: COSTALLES JR., ANTONIO STA ANA

SEQ TAXPAYER
NO IDENTIFICATION
NUMBER
(1) (2)
------------------------------ ------------------------------
1 101-879-547-0000
1 101-879-547-0000
1 101-879-547-0000
2 724-080-866-0001
2 007-644-871-0000
2 009-140-527-0000
3 007-644-871-0000
3 484-715-106-0000
3 223-642-612-0000
4 205-392-470-0000
4 205-392-470-0000
5 223-642-612-0000
5 223-642-612-0000

Grand Total :

END OF REPORT
TO EXPANDED WITHHOLDING TAX & PAYEES WHOSE INCOME PAYMENTS ARE EXEMPT

CORPORATION
(Registered Name)

(3)
------------------------------

JINZO CARE PHARMACEUTICAL AND MEDICAL SUPPLIES

QMM HEALTH CARE PHIL. CORP
JL DIALMED TRADING CO
QMM HEALTH CARE PHIL. CORP
JVB MEDICAL SUPPLIES
ST TYKE INC
RBGM MEDICAL EXPRESS SALES INC
RBGM MEDICAL EXPRESS SALES INC
ST TYKE INC
ST TYKE INC
MENTS ARE EXEMPT

INDIVIDUAL ATC CODE

(Last Name, First Name, Middle Name)

(4) (5)
------------------------------ ------------------------------
GALVAN, NELLIE MARINAS WI010
GALVAN, NELLIE MARINAS WI010
GALVAN, NELLIE MARINAS WI010
WI158
WI158
WI158
WI158
WI158
WI158
WI158
WI158
WI158
WI158
 1ST MONTH OF THE QUARTER
NATURE OF PAYMENT AMOUNT OF
INCOME PAYMENT

(6)
------------------------------ ------------------------------
Professionals (Lawyers, CPAs, Engineers, etc.) - If the current year’s gross income did not 0
Professionals (Lawyers, CPAs, Engineers, etc.) - If the current year’s gross income did not 5000
Professionals (Lawyers, CPAs, Engineers, etc.) - If the current year’s gross income did not 0
Income payments made by top withholding agents to their local/resident supplier of 0
Income payments made by top withholding agents to their local/resident supplier of 0
Income payments made by top withholding agents to their local/resident supplier of 81071.42
Income payments made by top withholding agents to their local/resident supplier of 0
Income payments made by top withholding agents to their local/resident supplier of 38035.71
Income payments made by top withholding agents to their local/resident supplier of 0
Income payments made by top withholding agents to their local/resident supplier of 0
Income payments made by top withholding agents to their local/resident supplier of 99274.54
Income payments made by top withholding agents to their local/resident supplier of 0
Income payments made by top withholding agents to their local/resident supplier of 32142.86
------------------
255,524.53
 2ND MONTH OF THE QUARTER
TAX RATE AMOUNT OF AMOUNT OF
TAX WITHHELD INCOME PAYMENT

(7) (8) (9)

------------------------------ ------------------------------ ------------------------------
0 0 5000
5 250 0
0 0 0
0 0 0
0 0 95678.57
1 810.71 0
0 0 0
1 380.36 0
0 0 171428.58
0 0 0
1 992.75 0
0 0 0
1 321.43 0
------------------ ------------------ ------------------
9.00 2,755.25 272,107.15
 3RD MONTH OF THE QUARTER
TAX RATE AMOUNT OF AMOUNT OF
TAX WITHHELD INCOME PAYMENT

(10) (11) (12)

------------------------------ ------------------------------ ------------------------------
5 250 0
0 0 0
0 0 5000
0 0 201000
1 956.79 0
0 0 0
0 0 40821.23
0 0 0
1 1714.29 0
0 0 13012.5
0 0 0
0 0 257142.86
0 0 0
------------------ ------------------ ------------------
7.00 2,921.08 516,976.59
================== ==================
 TOTAL FOR THE QUARTER
TAX RATE AMOUNT OF TOTAL
TAX WITHHELD INCOME PAYMENT

(13) (14) (15)

------------------------------ ------------------------------ ------------------------------
0 0 5000
0 0 5000
5 250 5000
1 2010 201000
0 0 95678.57
0 0 81071.42
1 408.21 40821.23
0 0 38035.71
0 0 171428.58
1 130.13 13012.5
0 0 99274.54
1 2571.43 257142.86
0 0 32142.86
------------------ ------------------ ------------------
9.00 5,369.77 1,044,608.27
TOTAL
TAX WITHHELD

(16)
------------------------------
250
250
250
2010
956.79
810.71
408.21
380.36
1714.29
130.13
992.75
2571.43
321.43
------------------
11,046.10