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Any Taxes
2 Amended Return? 3 Withheld?
1 For the Month (MM/YYYY) 4 No. of Sheets Attached
5 ATC WW010
01 - January 2023 Yes No 0
Yes No
8 Withholding Agent's Name (Last Name, First Name, Middle Name for Individuals) /(Registered Name for Non-Individuals)
GLEM BROKERAGE CORPORATION
13Are you availing of tax relief under Special Law of International Tax Treaty?
13A If yes, specify
Yes No
Section A Continuation
Tax Paid(Excluding Penalties) for the
Should Be Tax Due for the Month Year (6) 7 Adjustments (7 = 6 - 5)
Month/Year (5)
Attachments
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