TRAIN LAW for RR 11-2018 INCOME PAYOR/WITHHOLDING AGENT’S SWORN DECLARATION

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       ___________

 

(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.

From: https://www.bir.gov.ph/index.php/revenue-issuances/revenue-regulations/2018-revenue-regulations.html