Paf# 20230104 6519652

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Machine Validation: VALID UNTIL: FEBRUARY 18, 2023

Republic of the Philippines

DEPARTMENT OF FINANCE
SECURITIES AND EXCHANGE COMMISSION
The SEC Headquarters
7907 Makati Avenue, Salcedo Village,
Barangay Bel-Air, Makati City, 1209

PAYMENT ASSESSMENT FORM No. 20230104-6519652


DATE RESPONSIBILITY CENTER
01/04/2023 CRMD
PAYOR: BAYANIHANG CALUMPITEñO INC.
CALUMPIT, BULACAN, REGION III (CENTRAL LUZON), 3003

NATURE OF COLLECTION QUANTITY ACCOUNT CODE AMOUNT


By Laws 1 4020102000 (606) 1,000.00
Registration of Corporation 1 4020102000 (606) 1,000.00
Registration of Membership Book 1 4020102000 (606) 75.00
Name Verification 1 4020199099 (678) 100.00
Legal Research Fee (A0823) 1 2020105000 (131) 20.00
Documentary Stamp Tax 1 4010401000 (4010401) 30.00
TOTAL AMOUNT TO BE PAID Php 2,225.00
Amount in words:
Assessed by:
TWO THOUSAND TWO HUNDRED TWENTY FIVE PESOS AND
ESPARC
00/100
Remarks:
PAYMENT OPTIONS BREAKDOWN SUMMARY
1. Online payment thru eSPAYSEC at FUND ACCOUNT AMOUNT ACCOUNT #
• https://espaysec.sec.gov.ph SEC RCC Current Account 2,175.00 3752-2220-44
2. Over the Counter Payments SEC BIR - DST 30.00 3752-2220-60
• SEC Cashier Office until Jan 31, 2023 BTR Account - LRF 20.00 3402-2844-46
• All Landbank Branches nationwide TOTAL Php 2,225.00

NOTES:
A. The Payment Assessment Form (PAF) is valid until FEBRUARY 18, 2023.

B. Accepted modes of payment at SEC Main Office, Makati City:


1. Cash 2. Manager's/Cashier's Check 3. Postal Money Order

C. Accepted modes of payment at Landbank branches:


1. Cash 2. Manager's/Cashier's Check payable to the Securities and Exchange Commission

D. For check payment, please prepare separate Manager's checks per fund account as indicated on the breakdown summary.

E. For over the counter payment at LandBank:


1. Print 2 copies of PAF, 1 Client Copy, 1 LandBank copy
2. Accomplish the onColl Payment slip per fund account as indicated on the breakdown summary.
Use the correct Fund Account and Account No. and provide the below information:
• Reference Number 1 - PAF No.
• Reference Number 2 - Name of Payor appearing on the PAF
3. Present OnColl Payment Slip, together with the PAF, to the LandBank Teller

F. Starting January 03, 2023, you may generate the electronic official receipt (eOR) by visiting https://espaysec.sec.gov.ph/eor
• Payment thru ESPAYSEC – eOR available upon payment
• LandBank OTC - eOR available within two (2) business days after the payment

G. ANY ALTERATIONS WILL INVALIDATE THIS FORM

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