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[{"$nulls":11}," "]
[]
[]
[1,"For the Period"]
[{"$nulls":3},"From",{"$nulls":8},"(MM/DD/YY)",{"$nulls":9},"To",{"$nulls":6},"(MM/DD/YY)"]
["Part I",null,null,"Income Recipient/Payee Information",{"$nulls":16},"Withholding Agent/Payor Information"]
[2,"TIN",{"$nulls":18},3,"TIN"]
[]
[4,"Payee's Name (For Non-Individuals )",{"$nulls":18},5,"Payor's Name (For Non- Individuals)"]
[]
[]
[6,"Payee's Name  (Last Name, First Name,  Middle Name) For Individuals",{"$nulls":18},7,"Payor's Name  (Last Name, First Name,  Middle Name) For Individuals"]
[]
[]
[8,"Registered Address",{"$nulls":18},9,"Registered Address"]
[]
[]
[{"$nulls":13},"8A  Zip",{"$nulls":16}," 9A Zip "]
[{"$nulls":14},"Code",{"$nulls":15},"     Code"]
[10,"Foreign Address",{"$nulls":13},"10A","  Zip  Code",{"$nulls":3},"10B    ICR No.   (For Alien  Income Recipient Only)"]
[]
[]
["Part II",null,null,"Details of Income Payment and Tax Withheld   (Attach additional sheet if necessary)"]
["Nature of Income Payment",{"$nulls":15},"A T C",{"$nulls":4},"Amount of Payment",{"$nulls":5},"Tax Withheld"]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
[" "]
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[" "]
[" "]
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[" "]
["Total",{"$nulls":20},0,{"$nulls":6},0]
[null,null,"We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by us, and to the best of our knowledge and belief, is true and "]
[null," correct pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof."]
[]
[null,"Payor/Payor's Authorized Representative/Accredited Tax Agent",{"$nulls":16},"TIN of Signatory",{"$nulls":5},"Title/Position of Signatory",{"$nulls":5},"Date Signed"]
[null,"Signature Over Printed Name"]
[]
[null,"Tax Agent Accreditation No./Attorney's Roll No. (if applicable)",{"$nulls":16},"Date of Issuance",{"$nulls":5},"Date of Expiry"]
[]
[null,"CONFORME:"]
[]
[null,"Payee/Payee's Authorized Representative/Accredited Tax Agent",{"$nulls":16},"TIN of Signatory",{"$nulls":5},"Title/Position of Signatory",{"$nulls":5},"Date Signed"]
[null,"Signature Over Printed Name"]
[]
[null,"Tax Agent Accreditation No./Attorney's Roll No. (if applicable)",{"$nulls":16},"Date of Issuance",{"$nulls":5},"Date of Expiry"]
[]
["To be accomplished for Value-Added Tax/Percentage Tax Withholding (substituted filing)"]
[null,"I declare, under the penalties of perjury,  that the information ",{"$nulls":16},"I declare under the penalties of perjury that I am qualified under substituted filing of Percentage "]
["herein stated are reported under BIR Form No. 1600  which",{"$nulls":16},"Tax/Value Added Tax Returns (BIR Form 2551M/2550M/Q), since I have only one payor from "]
["have been filed with the Bureau of Internal Revenue.",{"$nulls":16},"whom I earn my income; that, in accordance with RR 14-2003, I have availed of the Optional "]
[{"$nulls":17},"Registration under the 3% Final Percentage Tax Wthholding/10% Final VAT Withholding in lieu "]
[{"$nulls":17},"of the 3% Percentage Tax/10% VAT in order to be entitled to the privileges accorded  by the"]
[{"$nulls":17},"Substituted Percentage Tax Return/Substituted VAT Return System prescribed in the aforesaid "]
[null,"Payor/Payor's Authorized Representative/Accredited Tax Agent",{"$nulls":15},"Regulations; that, this Declaration is sufficient authority of the withholding agent to withhold 3% "]
[null,"Signature Over Printed Name",{"$nulls":15},"Final Percentage Tax/10% Final VAT from my sale of goods and/or services."]
[]
[null,"TIN of Signatory",{"$nulls":8},"Title/Position of Signatory",{"$nulls":6},"Payee/Payee's Authorized Representative/Accredited Tax Agent",{"$nulls":12},"Title/Position of Signatory"]
[{"$nulls":17},"Signature Over Printed Name"]
[]
[null,"Tax Agent Accreditation No./Attorney's Roll No. (if applicable)",{"$nulls":15},"Tax Agent Accreditation No./Attorney's Roll No. (if applicable)",{"$nulls":12},"TIN of Signatory"]
[]
[null,"Date of Issuance",{"$nulls":8},"Date of Expiry",{"$nulls":6},"Date of Issuance",{"$nulls":12},"Date of Expiry"]

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[]
["SCHEDULES OF ALPHANUMERIC TAX CODES"]
["Nature of Income Payment",null,"A T C "]
[null,null,"IND","CORP"]
["Income Tax"]
["     Fringe Benefit"]
[1,"Alien individual  employed by OBU's, Foreign Petroleum Service Contractors, & Subcontractors,","WF 320"]
[null,"     & by Regional or Area Headquarters & Regional Operating Headquarters of Multinational Co.,"]
[null,"      including any of its Filipino employees occupying the same position"]
[2,"Payment of fringe benefits to Non-Resident Alien Not Engaged in Trade or Business (NRAETB)","WF 330"]
[3,"Employees other than rank and file (Fringe Benefit Tax)","WF 360"]
["     Interest/Yield from Bank Deposits/Deposit Substitutes/Government Securities"]
[4,"Saving  Deposit","WI 161","WC 161"]
[5,"Time Deposit","WI 161","WC 161"]
[6,"Government Securities","WI 162","WC 162"]
[7,"Deposit Substitutes/Others","WI 163","WC 163"]
[8,"Foreign Currency Deposits","WI 170","WC 170"]
[9,"Preterminated Long Term Deposit/Investment",null,"WC 440"]
[null,"     Less than three (3) years","WI 440"]
[null,"     Three (3) years to less than four (4) years","WI 441"]
[null,"     Four (4) years to less than five (5) years","WI 442"]
["     All Others"]
[10,"Interest on foreign loans payable to NRFCs",null,"WC 180"]
[11,"Interest and other income payments on foreign currency transaction /loans payable to OBUs",null,"WC 190"]
[12,"Interest and other income payments on foreign currency transaction /loans payable to FCDUs",null,"WC 191"]
[13,"Cash dividend payment by domestic corporation to citizen & resident aliens/NRFC's","WI 202","WC 212"]
[14,"Property dividend payment by domestic corporation to citizens & resident aliens/NRFC's","WI 203","WC 213"]
[15,"Cash dividend payment by domestic corp. to NRFCs whose countries allowed tax deemed paid credit",null,"WC 222"]
[16,"Property dividend payment by domestic corp. to NRFCs whose countries allowed tax deemed paid credit",null,"WC 223"]
[17,"On other payments to NRFC",null,"WC 230"]
[18,"Cash dividend payment by domestic corporation to NRAETB","WI 224"]
[19,"Property dividend payment by domestic corporation to NRAETB","WI 225"]
[20,"Share of a NRAETB in the distributable net income after tax  of a partnership  (except General Professional","WI 226"]
[null,"     Partnership) of which he is a partner, or share in the net income after tax of an association, "]
[null,"     a joint account or a joint venture taxable as a corp., of which he is a member or a co-venturer"]
[21,"Distributive share of individual partners in a taxable partnership, association,","WI 240"]
[null,"     a joint account or a joint venture or consortium"]
[22,"Other royalty payments to citizens, resident aliens and NRAETB ","WI 250","WC 250"]
[null,"    (other than WI380 and WI 341) /domestic and resident foreign corporation"]
[23,"On prizes exceeding P10,000 & other winnings paid to individuals","WI 260"]
[24,"Branch profit remittances by all corporations except PEZA/SBMA/CDA registered",null,"WC 280"]
[25,"On the gross rentals, lease and charter fees derived by non-resident owner or lessor of foreign vessels",null,"WC 290"]
[26,"On the gross rentals, lease and charter fees derived by non-resident lessor of aircraft, ",null,"WC 300"]
[null,"     machineries and other equipment"]
[27,"Payment to Oil  Exploration Service Contractors/Sub-Contractors","WI 310","WC 310"]
[28,"Payment to Filipinos or Alien individuals employed by Foreign Petroleum Service Contractors/","WI 320"]
[null,"     Subcontractors, Offshore Banking Units and Regional or Area Headquarters and Regional Operating "]
[null,"     Headquarters of Multinational Companies occupying executive/managerial  and technical positions"]
[29,"Payments to Non-Resident Alien Not Engaged in Trade or Business (NRAETB) except on sale of shares","WI 330"]
[null,"      in domestic corporation and real property"]
[30,"Payments to non-resident individual/foreign corporate cinematographic film owners, lessors or distributors","WI 340","WC 340"]
[31,"Royalties paid to NRAETB on cinematographic films and similar works","WI 341"]
[32,"Final Tax on interest or other payments upon tax-free covenant bonds, mortgages, deeds of trust or ","WI 350"]
[null,"     other obligations under Sec. 57C  of the National Internal Revenue Code of 1997   "]
[33,"Royalties paid to citizens, resident aliens & non-resident alien engaged in trade  or business (NRAETB) ","WI 380"]
[null,"      on books, other literary works  & musical compositions"]
[34,"Payments to taxpayer enjoying Preferential Tax Rates/Tax Treaty Rates",null,"WC 390"]
[35,"Informer's cash reward to individuals/juridical person","WI 410","WC 410"]
[36,"Final Capital Gains Tax on Sale/Exchange or Other Disposition of Real Property","WI 450","WC 450"]
["For Business Tax"]
[37,"VAT Withholding  on  Purchase of Goods - Govt. Withholding Agent","WV 010"]
[38,"VAT Withholding  on  Purchase of Services - Govt. Withholding Agent","WV 020"]
[39,"VAT Withholding  on  Purchase of Govenrment Public Work Contracts ","WV 030"]
[40,"VAT Withholding on Purchase of Goods   (with waiver of privilege to claim input tax credits)","WV 014"]
[41,"VAT Withholding on Purchase of Services   (with waiver of privilege to claim input tax credits)","WV 024"]
[42,"Person exempt from VAT under Sec. 109 (v) ","WB 084"]
[43,"Tax on Winnings and Prizes (Sec. 126) (double/forecast/quinella/trifecta bets) - Gov't. Withholding Agent (4%)","WB 191"]
[44,"Tax on Winnings and Prizes on horse races/owners of winning racehorses (Sec. 126) - Gov't. Withholding Agent (10%)","WB 192"]
[45,"Tax on Winnings and Prizes (Sec. 126 ) (double/forecast/quinella/trifecta bets) - Private Withholding Agent (4%)","WB 193"]
[46,"Tax on Winnings and Prizes on horse races/owners of winning racehorses (Sec. 126 ) - Private Withholding Agent (10%)","WB 194"]
[47,"VAT Withholding on Non-residents - Gov't. Withholding Agent","WV 040"]
[48,"VAT Withholding on Non-residents - Private Withholding Agent","WV 050"]
["Legend:"]
["NRAETB = Non-resident Alien Engaged in Trade or Business                           NRFC = Non- resident Foreign Corporation               FCDU = Foreign Currency Deposit Unit"]
["NRANETB = Non-resident Alien Not Engaged in Trade or Business                  OBU = Offshore Banking Unit                                    PEZA = Philippine Export Zone Authority"]
["SBMA = Subic Bay Metropolitan Authority                                                          CDA = Clark Development Authority"]