(To be filled up the BIR) DLN: PSIC: PSOC: BIR Form No. Republika ng Pilipinas Kagawaran ng Pananalapi 0605 Payment Form Kawanihan ng Rentas Internas July 1999 (ENCS) Fill in all applicable spaces. Mark all appropriate boxes with an "X" 1 2 7 For the Calendar Fiscal 3 Year Ended ( MM / YYYY ) Return Period ( MM / DD / YYYY ) Quarter Due Date ( MM / DD / YYYY) 8 2nd 3rd 6 ATC 4th BCS No./Item No. (To be filled up by the BIR) Tax Type Code Background Taxpayer Identification No. Information 10 RDO Code 11 Taxpayer Classification I 13 5 No. of Sheets Attached 1st Part I 9 4 12 Line of Business/Occupation N Taxpayer's 14 Telephone Number Name (Last Name, First Name, Middle Name for Individuals) / (Registered Name for Non-Individuals) 15 Registered Address 16 Zip Code 17 Manner of Payment Voluntary Payment Self-Assessment Per Audit/Delinquent Account Penalties Tax Deposit/Advance Payment 21 Installment Preliminary/Final Assessment/Deficiency Tax No. of Installment Accounts Receivable/Delinquent Account Partial Income Tax Second Installment Payment (Individual) Full Others (Specify) Payment Part II 19 20 18 Type of Payment Computation of Tax 19 Basic Tax / Deposit / Advance Payment Add: Penalties Surcharge 20A 20B Interest Compromise 20C 20D Total Amount Payable (Sum of Items 19 & 20D) 21 For Voluntary Payment For Payment of Deficiency Taxes From Audit/Investigation/ Delinquent Accounts APPROVED BY: I declare, under the penalties of perjury, that this document has been made in good faith, verified by me, and to the best of my 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. 22B 22A Signature over Printed Name of Taxpayer /Authorized Representative Part III Title/Position of Signatory Signature over Printed Name of Head of Office D e t a i l s of P a y m e n t Particulars Drawee Bank/Agency Number MM 23 Cash/Bank DD YYYY Amount 23 Debit Memo 24A 24B 17C 24C 24D 25B 25C 26C 26D 24 Check 25A 25 Tax Debit Memo 26A 26B 19C 26 Others Machine Validation/Revenue Official Receipt Details (If not filed with the bank) Taxpayer Classification: I - Individual N - Non-Individual Stamp of Receiving Office and Date of Receipt
