BIR Form No.

1600PTv2018 Page 1 of 1

BIR Form No. Monthly Remittance Return

1600-PT of Other Percentage Taxes Withheld
January 2018 Enter all required information in CAPITAL LETTERS using BLACK ink. Mark applicable boxes with an "X".
Page 1 Two copies MUST be filled with the BIR and one held by the Taxpayer.
1600-PT 01/18 P1

1 For the month 2 Amended Return? Yes No 3 Any Tax Withheld? Yes No 4 Number of
(MM/20YY)
03 /20 24 Sheet/s Attached
0

Part I - Background Information

5 Taxpayer Identification Number (TIN) 004 086 033 - 000 - - 6 RDO Code 020
7 Withholding Agent's Name (Last Name, First Name, Middle Name for Individuals OR Registered Name for Non-Individuals)
BARANGAY TALISAY
8 Registered Address (Indicate complete address. If branch, indicate the branch address. If the registered address is different from the current address, go to the RDO to update registered address by using BIR Form
No. 1905)

TALISAY BALANGA CITY BATAAN

8A Zip code 2100

9 Contact Number 0977-7284-431 10 Category of Withholding Agent Private Government

11 Email Address barangaytalisay69@gmail.com

12 Are you availing of tax relief under Yes No 12A If Yes, specify
Special Law or International Tax Treaty?
PART II - Computation of Tax
ATC Tax base Tax Rate Tax Withheld
13 % 0.00
14 % 0.00
15 % 0.00
16 % 0.00
17 % 0.00

18 Total Taxes Withheld (Sum of Items 13 to 17) 0.00

19 Less: Taxes Remitted in Return Previously Filed, if this is an Amended Return 0.00

20 Other Payments Made (attach proof) 0.00

21 Total Tax Payments Made (Sum of Items 19 & 20) 0.00

22 Tax Still Due/(Overremittance) (Item 18 Less Item 21) 0.00

Add: Penalties 23 Surcharge 0.00

24 Interest 0.00

25 Compromise 0.00

26 Total Penalties (Sum of Items 23 to 25) 0.00

27 TOTAL AMOUNT STILL DUE/(Overremittance) (Sum of Items 22 and 26) 0.00

If overremittance, apply for tax refund using BIR Form No. 1914 (Application for Tax Credits / Refunds).
I/We declare under the penalties of perjury that this return and all its attachments, have been made in good faith, verified by me/us, and to the best of my/our knowledge and belief, is true and correct,
pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Furthur, I/we give my/our consent to the processing of my/our
information as contemplated under the "Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes. (If Authorized Representative, attach authorization letter)
For Individual: For Non-Individual:

Signature over Printed Name of Taxpayer/Authorized Representative/Tax Agent Signature over Printed Name of President/Vice President/Authorized Officer or
(Indicate Title/Designation and TIN) Representative/Tax Agent (Indicate Title/Designation and TIN)

Tax Agent Accrediation No. / Date of Issue Date of Expiry

Attorney's Roll No. (if applicable) (DD/MM/YYYY/) (DD/MM/YYYY/)

Part III - Details of Payment

Drawee Bank/
Particulars Agency
Number Date (MM/DD/YYYY) Amount
28 Cash/Bank Debit Memo
29 Check
30 Tax Debit Memo
31 Others (specify)

Stamp of Receiving Office/AAB and Date of Receipt

Machine Validation / Revenue Official Receipt Details (if not filed with an Authorized Agent Bank)
(RO's Signature/Bank Teller's Initial)

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