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ANNEX C-1

Republic of the
Philippines
DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE

Date: _________

REPORT OF NO LATE RETURNS FILED/RECEIVED UNDER


REVENUE REGULATIONS NO. ____
This is to report that based on official records, no late returns were filed with or received
by Revenue District Office (RDO) No.___, Revenue Region No. ____ / LT Division _____ /
LTDO _____ under my jurisdiction for the period ______ to ______, 20__.
I declare, under the penalties of perjury, that this report has been made in good faith,
verified by me, and to the best of my knowledge and belief is a true, correct and complete report
pursuant to the provisions of the National Internal Revenue Code, as amended, and the
regulations issued under authority thereof.
Approved by:
_________________________
(Signature Over Printed Name)
Revenue District Officer/
Chief, LTDO or LT Division

Prepared by:
___________________________
Chief, Collection Section
______________________________
Chief, Document Processing Section

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