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SI*#ll#J#{ffiffitf;i &?eSg}Af}^. ZJIIS{}I$

 .<rt Bank of the Philippines

BIR TAX PAYMENT DEPOSIT SLIP Date: JUN l,ZOlq

Account Name: BTR.BIR CASH PAYMENT CHECK PAYMENT
No. of Amount Bank Check Amount
Account No. 0 405-027020-080 Denomination
Pcs. Pesos Initial
Branch
Number Pesosl Ctvs.
lcw.,

Tuxpayer Name: r 000.00 , lpoo oo

Aurt ,<ogE T. Dof?9TEo s00.00 I 500 oO
TIN:$Iz1-el3-5@@l I Tax Type: R,F 200.00
Tax Period: l\Btlloll. I fax Form: OGOS 100.00 ? 3@ o€
n
rl
Cash
Check
50.00
24.04
[]' Bank Debit Memo: 10.00
t I Savings Account # Coins 2 5 0g
t ] Current Account # Total Cash Payment l, 605 ?g Total Check Payment
Tax Debit Memo (TDM) II\STRUCTIONS
Number: 1. To be accomplished in 3 copies distributed as fqllpws: Original'Taxpayer's copy, Duplicate - AAB's eopy,
Triplicate - to be attached to the Return.
Amount: 2. In case of partial payment thru TDM, check the appropriate boxes (TDM, Cash or Check). a ph[tocopy of the Tax
Credit Certificate (TCC), front and back page, which was the sotrrce of the TDM, togethe! with a copy of
the TDM must be required fromlhe taxpayer and attached to the BIR tax return/payment form.

Tbtat Amoun t 0) E f AougXuD- Et6!{f 3. This deposit slip shall be used exclusively in payment of Internal Revenue Taxes.
4. This deposit slip is not valid without machine validation and initial of the teller.
Hi'ieiieD 5. Taxpayer nlay confirm their Tax pbyment with their Home RDO/LTDO or LTDO/RDO where they are
g l,go5. g? )
required to file tax returns/payment form and pay internal revenub taxes.

S i gna!-ury o f Taxp.ayerlRepre s entative :

MACHINE VALIDATION:
Date : 0710u19 14:36
Acct No: I$N: 134
'.' ,, -.:.,::,1 :l :l::.M- Amount : PHP *xx*xxxx1,805.98 DBP DBP Ipil
/ Teller : IPIJ |(ENNET}i 0, BALAR0

This is your, receipt when machiRe validated.

ocs 03111
(Rev I - 27Mayl3)