Monthly Remittance Return of Final Income Taxes Withheld

Monthly Remittance Return of Final Income Taxes Withheld

(To be filled up by the BIR) DLN: PSIC:

Fill in all applicable spaces. Mark all appropriate boxes with an “X”.

1 For the month of 2 Amended Return? Yes No 3 No. of Sheets Attached? 4 Any Taxes Withheld? Yes No

Part I Background Information

5 TIN 6 RDO Code 7 Line of Business

8 Withholding Agent's Name 9 Telephone No.

10 Registered Address 11 Zip Code

12 Category of Withholding Agent 13 Are there payees availing of tax relief under Special Law or Private Government International Tax Treaty? Yes No If yes, specify

Part II Computation of Tax

A. Details of Interest Payments and Tax Withheld Based on Regular Rates

Savings Deposit

14 Individual ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

15 Corporation ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

Time Deposit

16 Individual ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

17 Corporation ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

Deposit Substitute/Others

18 Individual ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

19 Corporation ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

Government Securities

20 Individual ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

21 Corporation ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

Preterminated Long-term Deposits/Investments

22 Individual ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

23 Corporation ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

Foreign Currency Deposit

24 Individual ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

25 Corporation ATC Total Interest/Yield Paid/Accrued Tax Rate BSP Exchange Rate Tax Required to be Withheld

26 Total Tax Required to be Withheld Based on Regular Rates (Sum of Items 14C to 22C, F, I, 23C, 24D, 25D)

B. Details of Interest Payments and Tax Withheld Based on Tax Treaty Rates

Treaty Code ATC Total Interest Tax Rate Tax Required to be Withheld

Treaty Code ATC Total Interest Tax Rate Tax Required to be Withheld

29 Total Tax Required to be Withheld Based on Tax Treaty Rates (Sum of Items 27D to 28D)

C. Details of Interest Payments to Taxpayers enjoying Preferential Tax Rates (i.e. PEZA Registered Enterprises)

ATC Total Interest Tax Rate Tax Required to be Withheld

ATC Total Interest Tax Rate Tax Required to be Withheld

32 Total Tax Required to be Withheld Based on Preferential Rates (Sum of Items 30D to 31D)

33 Total (Sum of Items 26, 29 & 32)

34 Less: Tax Remitted in Return Previously Filed, if this is an Amended Return

35 Tax Still Due/(Overremittance)

36 Add: Penalties

37 Total Amount Still Due / (Overremittance) (Sum of Items 35 & 36D)

I declare, under the penalties of perjury that this return 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.

Part III Details of Payment

Particulars / Drawee Bank/Agency Number / Date / Amount

40 Cash/Bank Debit Memo

Drawee Bank/Agency Number Date Amount

41 Check

A B C D

42 Others

A B C D

Machine Validation/Revenue Official Receipt Details (If not filed with the bank)

Date of Receipt

BIR Form 1602 (ENCS) - Page 2

Schedule 1 Summary of Interest/Yield Paid and Accrued for the Month

1 On Deposit Liabilities

Taxable Exempt

2 On Bills Payables/Borrowed Funds

Taxable Exempt

3 Long Term Deposit on Investment

Four (4) years to less than five (5) years

Three (3) years to less than four (4) years

Less than three (3) years

Exempt

4 Others

Taxable Exempt

Total Interest Expense per Books/FS

Schedule 2 Schedule of Tax Treaty Code

Use the treaty code list shown in the PDF, including AU Australia, AT Austria, BE Belgium, BR Brazil, CA Canada, CN China, DK Denmark, FI Finland, FR France, DE Germany, HU Hungary, IN India, ID Indonesia, IT Italy, JP Japan, KR Korea, MY Malaysia, NL Netherlands, NZ New Zealand, PK Pakistan, RO Romania, RU Russia, SG Singapore, ES Spain, SE Sweden, CH Switzerland, TH Thailand, GB United Kingdom, US USA.