BIR Form 1604-E

Annual Information Return of Income Taxes Withheld on Compensation and Final Withholding Taxes

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

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

1 For the Year 2 Amended Return? Yes No 3 No of Sheets Attached

Part I Background Information

4 TIN

5 RDO Code 6 Line of Business/Occupation

7 Withholding Agent's Name

8 Telephone No.

9 Registered Address 10 Zip Code

11 In case of overwithholding/overremittance after the year-end adjustment on compensation, have you released the refund/s to your employee/s? Yes No If yes, specify the date of refund

12 Total Amount of Overremittance on Tax Withheld under Compensation 13 Month of First Crediting of Overremittance 14 Category of Withholding Agent Private Government

Part II Summary of Remittances

Schedule 1 Remittance per BIR Form No. 1601-C

Date of Remittance: Name of Bank/Bank Code/ROR No., if any: Total Amount Remitted:

JAN FEB MAR APR

MAY JUN JUL AUG

SEP OCT NOV DEC

Schedule 2 Remittance per BIR Form No. 1601-F

Date of Remittance: Name of Bank/Bank Code/ROR No., if any: Taxes Withheld: Total Amount Remitted:

Schedule 3 Remittance per BIR Form No. 1602

Date of Remittance: Name of Bank/Bank Code/ROR No., if any: Taxes Withheld: Total Amount Remitted:

Schedule 4 Remittance per BIR Form No. 1603

Date of Remittance: Name of Bank/Bank Code/ROR No., if any: Taxes Withheld: Total Amount Remitted:

We declare, under the penalties of perjury, that this declaration has been made in good faith, verified by us, and to the best of our 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.

Stamp of Receiving Office and Date of Receipt

Part III Alphabetical List of Employees/Payees from whom Taxes were Withheld

Schedule 5 Alphabetical List of Payees Subject to Final Withholding Tax

SEQ NO. TIN Name of Payees Address of Payees

Status ATC Nature of Income Payment

Amount of Income Rate of Tax Amount of Tax Withheld

Schedule 6 Alphabetical List of Employees Other Than Rank and File Who Were Given Fringe Benefits During the Year

SEQ NO. TIN Name of Employee ATC

Amount of Fringe Benefit Grossed-Up Monetary Value Amount of Tax Withheld

Schedule 7 Alphabetical List of Employees/Payees from whom Taxes were Withheld

This document contains multiple sub-schedules (7.1 to 7.5) shown as tables in the PDF. Use repeated rows below as needed.

Schedule 7.1 Alphalist of Employees Terminated Before December 31

SEQ NO. TIN Name Inclusive Date of Employment

Schedule 7.2 Alphalist of Employees Whose Compensation Income Are Exempt from Withholding Tax but Subject to Income Tax

SEQ NO. TIN Name Taxable Income Tax Due

Schedule 7.3 Alphalist of Employees as of December 31 with No Previous Employer Within the Year

SEQ NO. TIN Name Basic Salary

Schedule 7.4 Alphalist of Employees as of December 31 with Previous Employer/s Within the Year

SEQ NO. TIN Name Gross Compensation Income

Schedule 7.5 Alphalist of Minimum Wage Earners

SEQ NO. TIN Name Gross Compensation Income

Guidelines and Instructions