BIR Form No.

Republic of the Philippines APPLICATION FOR CONTRACTOR'S FINAL

Department of Finance
Bureau of lnternal Revenue PAYMENT RELEASE CERTIFICATE
Enter all required information in CAPITAL LETTERS using BLACK ink. Mark ail applicable
0217
boxes with an "X". Two copies must be filed with the BIR and one held by the taxpayer. November 2014 (ENCS)

I Taxpayer ldentification Number (TlN)

Name, First Name, Middle Name far lndividual)ftResiitercd Name for

APPLIED FOR RELEASE OF FIHAL PAYMENT

10 Project lD lt{umber

13 Total Contract Price

Less: Amount previously collected and taxes withheld

16 Creditable Withholding Tax (2o/o)

17 Total Amount previously collected and taxes wifhheld ($umof #ems tato.!,6)

18 Collectible Final Paymenl (ltem 13less ftem lV)

Signature over Printed Name of PresidenVTreasure/Manager

(indicate titlel position)

19 Collectible Final Paymenl {fron ttem t8)

Less: 20 Taxes to be withheld
20A FinalWithholding VAT (5%)
208 Creditable Withholding Tax (2o/o)
20C Total Taxes Withheld lSum of ttems 20A & 208)
21 Others
21A
21F _______
21C Total Others (Sum of llems 21A & 218)
22 Net Collectible Final Payment (ttem 19 less ttems 2AC & 21C)

This certification is issued as a requisite before the release of final payment by the Department of Public Works and
Highways (DPWH) pursuant to Joint Memorandum of Agreement dated July 13, 1992 between the DPWH and the
Department of Finance, as implemenied by Revenue Memorandum Order (RMO) No. 39-92 dated September 9, '1992. This
does not relieve the subject taxpayer from any tax liabilities that may be found later on.

Name of Authorized Officer

(Signature over Printed Name)