"Annex A"

MONTHLY REPORT OF DOCUMENTARY STAMP TAX COLLECTION AND REMITTANCE

_________________________________________________________________________
Name of Government Agency :
Period Covered

INCLUSIVE SERIAL NO. OF CERTIFICATIONS AMOUNT OF DST

DATE ISSUED
NUMBER OF GOR ISSUED COLLECTED

       
       
       
       
       
       
       
       
       

TOTAL      

AMOUNT REMITTED      
DATE REMITTED      
AAB WHERE REMITTED      

PREPARED BY:

NOTED BY:

Head of Agency

(Report to be submitted by the Government Agency)