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Improperly Accumulated Earnings Tax Return: BIR Form No
Improperly Accumulated Earnings Tax Return: BIR Form No
Fill in all applicable spaces. Mark all appropriate boxes with an “X”.
1 For the Calendar Fiscal 3 Amended Return? 4 No. of sheets attached 5 ATC
2 Year Ended
( MM / YYYY ) I C 3 7 0
Yes No
Part I Background Information
6 TIN 7 RDO Code 8 Line of Business/
Occupation
9 Taxpayer's Name
13 Taxable Income 13
14 Add: Income exempt from Tax
14A 14B
14C 14D
15 Income excluded from Gross Income
15A 15B
15C 15D
We declare, under the penalties of perjury, that this return has been made in good faith, verified by us, and to the best of our 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.
27 28
President/Vice-President/Authorized Representative Treasurer/Asst. Treasurer/Authorized Representative
(Signature over printed Name) (Signature over printed Name)
29 30 31 32
Part III D e t a i l s of P a y m e n t
Drawee Bank/ Date
Particulars Agency Number MM DD YYYY Amount
33 Cash/Bank 33 Stamp of Receiving
Debit Memo……………………………………………………………………………. Office and
34 Check 34A 34B 34C 34D Date of Receipt
35 Tax Debit 35A 35B 35C
Memo……………………………
36 Others 36A 36B 36C 36D
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
Schedule I
Schedule of amount reserved for the reasonable needs of the business
(emanating from the covered year's taxable income)