8/19/2019 BUREAU OF INTERNAL REVENUE FORM 1604E 2016

1/2

 

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1 For the "ear  2  #$ended Return% 3 &o of 'heets #ttached

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Part I B a c k g r o u n d I n f o r m a t i o n

4 TI& 5 R *ode

  ccupation7 +ithholdin, #,ent-ayor/s &a$e (0ast &a$e1 First &a$e1 Middle &a$e for Indi2iduals)-(Re,istered &a$e for &on3Indi2iduals)

9 Re,istered #ddress

11 *ate,ory of +ithholdin, #,ent ri2ate 4o2ern$ent

Part II S u m m a r o f ! " m i t t a n c " #

Sc$"du%" 1 !"mittanc" &"r BI! 'orm No( 1)*1 + ,

#T5 F M5 F B#&6-B#&6*5-   T#5' TT#0 #M7&T

M&T8 R5MITT#&*5 RR &.1 IF #&" +IT8850 5TI5' R5MITT5

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Sc$"du%" 2 !"mittanc" &"r BI! 'orm No( 1)*)

#T5 F M5 F B#&6-B#&6*5-   T#5' TT#0 #M7&T

M&T8 R5MITT#&*5 RR &.1 IF #&" +IT8850 5TI5' R5MITT5

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Part III -LP.-B,/IC-L LIS/S O' P-0,,S 'ormat On%

Sc$"du%" 3 -LP.-LIS/ O' O/.,! P-0,,S .OS, INCO, P-0,N/S -!, ,,P/ '!O I/..OLDIN6 /- B/ SB8,C/ /O INCO, /- !"&ort"d nd"r 'orm 23*4

'5;   Taxpayer M5 F #"55' #T* T7R5 F I&*M5 #M7&T F I&*M5

&.   Identification (0ast &a$e1 First &a$e1 Middle &a$e for  #"M5&T #"M5&T

Indi2iduals1 co$plete na$e for &on3indi2iduals)

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I declare1 under the penalties of perury that this return has been $ade in ,ood faith1 2erified by $e1 and to the 'ta$p of Recei2in, ffice

best of $y knowled,e and belief1 is true and correct1 pursuant to the pro2isions of the &ational Internal Re2enue *ode1 and ate of Receipt

as a$ended1 and the re,ulations issued under authority thereof.

12 13

Taxpayer-#uthoriCed #,ent 'i,nature o2er rinted &a$e Title-osition of 'i,natory

  ) 0ine of Business-

Telephone &o.

1*  Dip *ode

  Number (TIN)

  1)*4+,  Republika n, ilipinas

6a,awaran n, ananalapi

6awanihan n, Rentas Internas

 

9uly

8/19/2019 BUREAU OF INTERNAL REVENUE FORM 1604E 2016

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BIR For$