REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE
Revenue Region No. 8
Revenue District Office No. 049
North Makati

MEMORANDUM FOR:
The Regional Director
This Region
Subject: REPORT ON THE WITNESSING OF STOCK DESTRUCTION

Submitted herewith is the result of witnessing the destruction of damaged / obsolete / expired products of:
Name of Requesting Party: HEALOL PHARMA CORPORATION TIN: 007-295-289-000
Address: Unit 406 4th Floor ITC Building, 337 Senator Gil Puyat Avenue, Makati City
Name of Legal Owner: "SAME AS THE ABOVE" TIN:
Address: "SAME AS THE ABOVE"
Business / Trade Name: "SAME AS THE ABOVE" TIN:
Pursuant to Referral Authority No.

The purpose of such request is for: X Claim as inventory loss or deduction for income tax purpose.

Replacement, Reimbursement or Credit Memo / Offset

Support Document
Insurance Claim

Others, Please specify

Total declared value of stocks / inventory: P 2,004,103.13

1. Findings during destruction: Less: Recovery on destructed items:

Allowable Inventory deduction P 2,004,103.13

Date/s of destruction: November 20, 2017 Place of Destruction: Brgy. Magsilo, Malabon City

Product/s subject of destruction: Please see attached list of details

2. Manner of destruction: XXX Burning Breaking

Dumping on Contents Others: Please specify:

Other findings:

XXX 3. Letter - request

XXX 4. Application for Inventory / Assets Disposal / Destruction / Loss
XXX 5. Affidavit of Ownership / Sworn Statement of Goods as Waste or Obsolete
XXX 6. Pictures taken before and after stock destruction in the presence of BIR

7.Others: Please Specify

Recommendations: XXX For approval of the report For disapproval

XXX For issuance of Certificate that Revenue Officer/s had witnessed the
destruction
Others, Please specify:
Submitted by: Attested by:

John Louie O. Esguerra Maria Lina M. Aficial

Witness/Revenue Officer Group Supervisor

Recommending Approval:

Atty. Shirley A. Calapatia

Revenue District Officer