ANNEX “A”

APPLICATION FOR ABATEMENT PROGRAM

(Under Revenue Regulations No. _________)

______________________
(Date)
The Commissioner of Internal Revenue
_______________________________
_______________________________
_______________________________

Dear Sir/Madam:

Please consider this as an application for abatement under Revenue Regulations No.
___________. The following is/are my/our deficiency tax/es or assessment/s:

Name of Taxpayer : _____________________________________________

Address : _____________________________________________
TIN : ________________________
Taxable Year Covered : ________________________

Assessment Notice No. :

Type of Tax :
Total Amount:
Basic
Surcharge
Interest
Compromise Penalty
Status of the Case :

Attached is the triplicate copy of Abatement Program Payment Form (BIR Form No.
0618) reflecting payment of 100% of the basic tax due in the amount of P _________________.

Very truly yours,

_________________________________
Taxpayer/Authorized Representative
(Signature Over Printed Name)

___________________________
Position
Contact person/s:
Name: _______________________________
Telephone No.: ________________________
E-mail Address: ________________________