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DLN:
PSIC:
PSOC:
Compromise Settlement
Payment Form
Republika ng Pilipinas
Kagawaran ng Pananalapi
0608
July 2001
Fill in all applicable spaces. Mark all appropriate boxes with an "X"
1
2
For the
Calendar
Fiscal
1st
2nd
3rd
No. of Sheets
ATC
Background
Taxpayer's
M C 0 3 0
4th
Information
10 RDO Code
11 Taxpayer Classification
I
13
Attached
Part I
9
Year Ended
( MM / YYYY )
Quarter
12 Line of Business/Occupation
(Last Name, First Name, Middle Name for Individuals) / (Registered Name for Non-Individuals)
14 Telephone Number
Name
15 Registered
Address
16 Zip Code
17 Manner of Payment
SPF-(Compromise Settlement)
Others (Specify)
18 Remarks
Part II
Computation of Tax
19 Compromise Settlement:
Doubtful Validity of Assessment
Financial Incapacity
Amount Payable
19
APPROVED BY:
Stamp of Receiving
Office
I declare, under the penalties of perjury, that this document has been made
in good faith, verified by me, and to the best of my knowledge and belief, is true
and correct, pursuant to the provisions of the National Internal Revenue Code,
as amended, and the regulations issued under authority thereof.
20B
20A
Signature over Printed Name of Taxpayer /Authorized Representative
Part III
Title/Position of Signatory
D e t a i l s of P a y m e n t
Particulars
Drawee Bank/Agency
MM
Number
21 Cash
22 Check
DD
YYY
Amount
21
22A
22B
17C
22C
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
Taxpayer Classification:
I - Individual
N - Non-Individual
22D
TAX
Code
IT
CG
CS
ES
DN
VT
PT
ST
SO
SL
DS
XS
XV
XF
Description
INCOME TAX
IMPROPERLY ACCUMULATED EARNINGS TAX
CAPITAL GAINS TAX - Real Property
CAPITAL GAINS TAX - Stocks
ESTATE TAX
DONOR'S TAX
VALUE-ADDED TAX
PERCENTAGE TAX
PERCENTAGE TAX - STOCKS
PERCENTAGE TAX - STOCKS (IPO)
PERCENTAGE TAX - SPECIAL LAWS
DOCUMENTARY STAMP TAX
EXCISE - SPECIFIC TAX
EXCISE TAX - AD VALOREM
TOBACCO INSPECTION & MONITORING FEES
TYPE
Code
WB
WC
WE
WF
WG
WO
WR
WW
Description