CONVERGE INFORMATION AND COMMUNICATIONS

TECHNOLOGY SOLUTIONS, INC.

New Street Building, Mac Arthur Highway
Balibago, Angeles, Pampanga 2009
VAT Reg TIN : 006-895-049-000
OFFICIAL RECEIPT REPRINT
OR-0000000009827683
Customer Name MR. JEREMIAS PUSTA ROQUE
Address ROOM 309 , BLOCK 95 LOT 1 R PAPA ST.,
WESTERN BICUTAN, AFPOVAI PHASE 4, Date 06/13/2024
WESTERN BICUTAN, CITY OF TAGUIG, Account No. 1680000766460
METRO MANILA, FOURTH DISTRICT, 1630
TIN No.
Business Style

Transaction Details Amount

Main line fee PHP 4,500.00
Less: Withholding Tax PHP 0.00
Withholding Tax-VAT PHP 0.00
Net Amount Paid PHP 4,500.00
Mode of payment
Bank(Paynamics) VATable Sales PHP 4,017.86
Zero-rated Sales PHP 0.00
Exempt Sales PHP 0.00
VAT amount PHP 482.14
Total PHP 4,500.00

"THIS IS A SYSTEM GENERATED DOCUMENT UNDER A COMPUTERIZED ACCOUNTING SYSTEM"

Acknowledgement Certificate No Date Issued Series Range System Name Date Generated
21A-CAS-2022-12-0002 12/16/2022 0000000000000000 - HOBS v8.2 06/13/2024
9999999999999999