> a ANNEX “B.2" INCOME PAYEE’S SWORN DECLARATION OF GROSS RECEIPTS/SALES (For Self-Employed and/or Engaged in the Practice of Profession with Lone Income Payor) 1 _ClAtA ERIKA R- BepwiLeno FILIPINO of legal age, single/ marred 19 y — _ emanating B32 CONMMIE C4b0-, bubs, GEN ffnls City wih ‘Taxpayer Identification Number (TIN) 293 - HO + F5b- O01 ___, afte: having been duly sworn in accordance with law: hereby depose and state: 1. That I derived my PROFESS1ONAL _ income only trom _L« > rx oles) ~ ‘(iar ofcane Payee aly _ with Taxpayer Mdentitication Number _UOS - (3) ~Yftpinfbtkiness address at CUM L bo My OFFICE , ND FLOOR INVECrMENT AemON CENTER , CIM Hoppe DUIVE, Gew SANTOS CITT That for the current year 2019. my that Lam registered asa non-VAT taxp tole my Income Tax Return on the 035 receipts will not exceed Two Hundred Filly Thousand Pesos (0250.00.00) and yer: that whatever sche amount of income received, {will comply with the equitement eseribed duc date. For this purpose, | opto avail of either one ofthe following: Graduated tneome Tax Rates under Section, 24(A)(2)(a) ofthe Tax Code, as amended, based on the taxable income. With this seletion, acknowledge that Im subject 0% income tax, thus, not subject to creditable withholding tx; subject to percentage tax. if applicable, and will ile the required percentage tax returns oF subject to withholding percentage tx, in case of government money payments Bight Pereem (8%) income ax rate under Section 24(A)(2)(b) of the Tax Code, as amended, based on gross receipts/sales and other non-operating income - with this selection, I understand that this is in lieu of the fraduated income tax rates and the Percentage Tax under Section 116 ofthe Tax Code, as amended: thus, ‘ho withholding tax shall be made; 3. That based on my selection above, if my gross sales/receipts and other non-operating income exceeds P250, 000.00 but not over 3,000,000.00, my aforestated lone income payor shall automaticaly withhold the prescribed rate of withholding ts ‘4 Incase of Graduated Income Tax Rates, I acknowledge that aside fom income tax, am subject to business tax (Percentage Tax, if applicable) and creditable withholding of income in excess of P250,000.00, and business tax withholding, if any, are applicable on the entire income payment, OR }, Incase of Fight Percent (8%) income tax rie, acknowledge that {um only subject to income tax and thus to the creditable withholding income tax in excess of P250,000.00 4 That I duly execute this SWORN DECLARATION in compliance wih the requirement preseribed under Section 3 of Revenue Regulations No, 5. That | declare, under the penalties of pojury, that this declaration ha heon made in good faith, and to the best of my knowlede and belie tae rand comet IN WITNESS WHEREOF,|hunc hereunto st my hand this ayo ig HEEHAL SARTOS.CID, CinKA GRIKA 4 BaALILEND JAG 10 7339 SEAEKAL SANTOS CITY SUBSCRIBED AND SWORN to before me this day ot” 20_in —_ ot Applicant exhibited to mchisher issued at NOTARY PUBLICoh. PaymentForm 605 ty 1999,ENCS) able spaces. Mark all appropriate boxes wih an x fe) amen] Peas Ge To tecbam(MNTOOTYYIV | No cioieam [ATC arena goood ‘sacs piiiacea rae ee » etm Pood (HMTODTNVYY) | Tex Type code Bes Noten Ne (Tove es oT Re BAY & F ari Background information jp Tiasayer onion Ne rT. Taroaye/ Castillon [2 Une af BusnesslSoupton fe tenes Sp Yoana re (Lit ee Fear Mise Nae fer / ogres Na fo Nei ie aed | hezeoae | perce + 17 Mane Payment © 18 Tyee Pamrant ake Parent Pa natibeinqnt At joie sotdaocanert Crenetas (C]petninarna Asexsnenibetcene Tox | [se ot ratnent 2x Depoindanc Parent cts RacoaioDeingn ut Pata Inca Tx Second eta ayrart ‘cs - Ose Others (Spacty) 4 wh Payment cn Computation of Tax 12 Saxe Tax Depoat/ Adan Peprent ; 20 Aa rena terest + comeramae at Yet Anount Payer tae 188 200) af soc . Fer vor Payment TarFommanarDercara Teer | Samper Reconna From hatmesgtn once Dla Accuts | andDate ot Recep | cca ure erates tpi, tine documenta wen hopnoveD BY L ‘rs nod th Yo by, an best my roa : a bette an caret pus provost he Naor ae nena Revenue Code at amended, ane repuatos und under autor bert \ ihe a ae 7 Sea co — z one : mi - Se 1 “4 ie : al : : pia a 0 7 s = : : -| ~ ™ r : ii 8 a el LI fuachne Vataaten avons Oca Recest Daas rt he wih Pe [IR Frm 0605 (ENCS) PAGE 2 re [_satne oF paren lave (NATURE OF PAYMENT [ee ___|_sATURE OF pavwenve Application for ~~ *GR = So Titaamare REttctration 1901. srlmagrnanrer™ CT ; Teese em ar Tite spaces Mark alla res 14 3.0] [ere] 100, Rach eND, cram h CLIK Rubs FILIPINO 9\0 2.9 B) L32_Cenemnvius suB0 Sl 45 0,0 nay Seca eras Veh ra eee, a