REPUBLIC OF THE PHILIPPINES ANNEX C

DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE

TRANSMITTAL FORM
BIRs Copy

Type of Returns : * SRS 1604-E For the Year: 2017

Transmittal Number : _____________________ TIN: 000 - 280 - 753 -000

Name of Withholding Agent :Wrigley Philippines, Inc._
Address : Marcos Highway, Sitio Putting Bato, Brgy. Inarawan, Antipolo City
Name of Contact Person/WAs Representative: Junar G. Madali Tel. No.:667-7500
No. of Diskettes Submitted: ________
Received by: _______________ Office: ____________________
------ For returned diskette (to be resubmitted within 1 week) ------- Stamp
of
Labelling Virus found
Date returned: _____________ Date resubmitted: _____________ Receiving Office

---------------------------------------------------------------------------------- Date: __________

Uploaded Date of uploading: _______________
Not uploaded Reason: _______________________

# -----------------------------------------------------------------------------------------------------

REPUBLIC OF THE PHILIPPINES ANNEX C

DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE

TRANSMITTAL FORM
Taxpayers Copy

Type of Returns : * SRS 1604-E For the Year: 2017

Transmittal Number : _____________________ TIN: 000 - 280 753- 000

Name of Withholding Agent : Wrigley Philippines, Inc.
Address : Marcos Highway, Sitio Puting Bato, Brgy. Inarawan , Antipolo City
Name of Contact Person/WAs Representative: Junar G. Madali Tel. No: 667-7500
No. of Diskettes Submitted: ________
Received by: _______________ Office: ____________________

------ For returned diskette (to be resubmitted within 1 week) ------- Stamp
Labelling Virus found of
Date returned: _____________ Date resubmitted: _____________ Receiving Office
---------------------------------------------------------------------------------- Date: __________
UploadedDate of uploading: _______________
Not uploaded Reason: _______________________