Republika ng Pilipinas Certificate of Compensation BIR Form No.

Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas

For Compensation Payment With or Without Tax Withheld

Payment/Tax Withheld 2316
July 2008 (ENCS)
Fill in all applicable spaces. Mark all appropriate boxes with an "X"
1 For the year 2 For the period
(YYYY) 2015 From (MM/DD) 01 01 To (MM/DD) 05 30
Part I Employee Information Part IV-B Details of Compensation Income and Tax Withheld from Present Employer
3 Tax Payer Amount
Identification No. TIN in Prc A. NON-TAXABLE/EXEMPT COMPENSATION INCOME
4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code
Ferrer, Drizza, Lagumen 000
32 Basic Salary/ 32
6 Registered Address 6A Zip Code Statutory Minimum Wage 0.00
1105 Minimum Wage Earner (MWE)
6B Local Home Address 6C Zip Code
33 Holiday Pay (MWE) 33
0.00
6D Foreign Address 6E Zip Code
34 Overtime Pay (MWE) 34
0.00
7 Date of Birth (MM/DD/YYYY) 8 Telephone number
35 Night Shift Differential (MWE) 35
06 14 1993 0.00
9 Exemption Status
36 Hazard Pay (MWE) 36
\ / Single Married 0.00
9A Is the wife claiming the additional exemption for qualified dependent children? 37 13th Month Pay 37
Yes No and Other Benefits 14,150.45
10 Name of Qualified Dependent Children 11 Date of Birth (MM/DD/YYYY) 38 De Minimis Benefits 38
13,103.31
39 SSS, GSIS, PHIC & Pag-ibig 39
Contributions & Union dues 4,338.50
(Employee share only)

40 Salaries & Other forms of 40

Compensation 229.89-
12 Statutory Minimum Wage rate per day 12
41 Total Non-Taxable/Exempt 41
Compensation Income 31,362.37
13 Statutory Minimum Wage rate per month 13

14 Minimum Wage Earner whose compensation is exempt from B. TAXABLE COMPENSATION INCOME
withholding tax and not subject to income tax
REGULAR
Part II Employer Information (Present)
15 Taxpayer 42 Basic Salary 42
Identification No. 205 366 921 000 45,575.30
16 Employer's Name 43 Representation 43
0.00
CONVERGYS PHILIPPINES, INC.
44 Transportation 44
17 Registered Address 17A Zip Code
0.00
45 Cost of Living Allowance 45
8th Floor SLC Building,6797 Ayala A 1226 0.00
\/ Main Employer Secondary Employer 46 Fixed Housing Allowance 46
Part III Employer Information (Previous)
0.00
18 Taxpayer
Identification No. 47 Others (Specify)

19 Employer's Name 47A 47A

NSDP15% 9,249.01
47B 47B
20 Registered Address 20A Zip Code
P4P 8,255.85

SUPPLEMENTARY
Part IV-A Summary
48 Commission 48
21 Gross Compensation Income from 21 105,993.92 0.00
Present Employer (Item 41 plus Item 55)
49 Profit Sharing 49
22 Less: Total Non-Taxable/ 22 31,362.37 0.00
Exempt (Item 41)
23 Taxable Compensation Income 23 74,631.55 50 Fees including Director's 50
0.00
from Present Employer (Item 55) Fees
24 Add: Taxable Compensation 24 0.00
Income from Previous Employer 51 Taxable 13th Month Pay 51 0.00
and Other Benefits
25 Gross Taxable 25 74,631.55
Compensation Income 52 Hazard Pay 52 0.00
26 Less: Total Exemptions 26 50,000.00
53 Overtime Pay 53
9,247.19
27 Less: Premium Paid on Health 27
and/or Hospital Insurance (if applicable)
28 Net Taxable 28
Compensation Income 24,631.55 54 Others (Specify)
54A 54A
29 Tax Due 29
1,963.16 EPGAL 1,264.40-
30 Amount of Taxes Withheld
30A Present Employer 30A
1,963.16 54B 54B
30B Previous Employer 30B 3,568.60

31 Total Amount of Taxes Withheld 31

55 Total Taxable Compensation
Income
55 74,631.55
As adjusted 1,963.16
We declare, under the penalties of perjury, that this certificate 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.
56 MELODY CUBILLA Date Signed 07 28 2017
Present Employer/Authorized Agent Signature Over Printed Name
CONFORME:
57 Ferrer, Drizza, Lagumen Date Signed
CTC No. Employee Signature Over Printed Name Amount Paid
of Employee Place of Issue Date of Issue

To be accomplished under substituted filing

I declare, under the penalties of perjury, that the information herein stated are reported under BIR I declare, under the penalties of perjury, that I am qualified under substituted filing of Income Tax
Form No. 1604CF which has been filed with the Bureau of Internal Revenue Returns (BIR Form No. 1700), since I received purely compensation income from only one
employer in the Phils. for the calendar year; that taxes have been correctly withheld by my
employer (tax due equals tax withheld); that the BIR form No. 1604CF filed by my employer to the
58 MELODY CUBILLA BIR shall constitute as my income tax return and that BIR Form No. 2316 shall serve the same
Present Employer/Authorized Agent Signature Over Printed Name purpose as if BIR Form No. 1700 had been filed pursuant to the provisions of RR 3-2002, as
(Head of Accounting/Human Resource or Authorized Representative) amended.

59 Ferrer, Drizza, Lagumen

Employee Signature Over Printed Name