BIR Form 2316

April 26, 2022

Ms. Juana Marie Protacio Rizal, single, is a private employee earning purely compensation for the taxable year 2022. Her
TIN is 541-082-874. Information pertaining to her are as follow:

Personal Information:
RDO 060
Address Tahimik Street., Brgy. XXX, Lucena City
Birthdate January 2, 1980
Employer/TIN San Miguelito Corp./006-897-578
Employer Add Maingay St., Brgy. I, Lucena City
CP # 09083515465
CTC No 58748462
Place/Date of Issue Lucena City/Jan. 17, 2023
Amount Php 257.00

Financial Information:
Gross Compensation Income 915,000
Personal Expenses 150,000
Overtime Pay 95,235
Hazard Pay 21,420
Cost of Living Allowance 13,000
13th Month pay and other benefits 127,860
De Minimis benefits 31,450
Royalties Income 10,000

Prepare a BIR Form 2316: You will act as the Employer Representative for signing dated April 3, 2023.