BIR Form No.

RePublika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Intemas
Payment Form 0605
September 2003(ENCS)

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7 Retum Period (MM / DD / YYYY) ;*ry +H^

Part I Background lnformation *ffi
I Taxpayer ldentification No. t 10 RDo code t t i"ip"v"i cl*.m""ti". --ffi ot ausinesyoccupation
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{i pffi* l t06i-i 0t 0tt I IRESTAURANT
13 Taxpayer's Name (Last Name, First Name, Middle Name for lndividuals) /(Registered Name for Non-lndividuals) l-i4 i;i'rc;;il,b*----
I p5i??6rr46i$-
l5 Registered Addr$s
pTREETSCAPE PHASE 2 PASEO SATURNTNO, MARTA LUTSA ROp
17 Manner of Payment
-**-T-***"*- r1 8 TYPe of Payment

Voluntary Payment i Per AudiVDelinquent Account I C lnstallment

O self-Assessment O Preliminary/Final Assess/Deficiency Tax
tl ruo. of lnstallment

0 Penalties O Accounts Receivable/Delinquent Account j0 eartiatPayment

0 Tax Deposit/Advance Payment l@ rrtt Payment
0 Income Tax Second Installment(Individual) i
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0 others(Specify)
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W Com putation of Tax

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19
20
Part l!
BasicTarDeposiuAdvance Payment
Add: Penalties
rere
21
20A I
Surcharge

Total Amount Payable(Sum of ltems 19 & 20D)

o.o0 208 0.00 20c ru
Compromise

0.00

O Pre-approved by lnvestigating Office O ttot approved by lnvestigating office ' I

For Payment of Deliciency Taxes
ForVoluntary Payment
From AudiUlnvestigation/*
Deliquent Account '
declare, under the penalties of perjury, that this document has been
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made in good faith, verified by me, and to the best of my knowledge and i
beliet is true and correct, pursuant to the provisions of National \
APPROVED BY:
lnternal Revenue code, rssued under 1

authority thereof.
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228
Signature Over Printed Name of
TiiiffiEffi;?sis-natory- Head of Ofrce /
Pa{t lll B*t*if * of Fsyrnent *4 m{+*= /
Parliculats : l lrinaig* tlanlv&F.l$1{:y I lthnrtr,rr i hlt { ,{rrx*nt
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Machine Validation/Revenue Official Receipt Details (lf not filed with the bank)

faxDaverClassification: I-lndividual N-Nonindividual