LBTI W2 Waiver - 2015 - Option2

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WAIVER

I, _______________, Filipino, of legal age, and currently an employee of LizardBear Tasking


Inc. with address at the _______________________________________________________,
hereby declare and state as follows:

1. I am a registered taxpayer with Tax Identification Number (TIN) _______________;


2. I joined LizardBear Tasking Inc. only on ________________ and I worked with another
Company (________________________), prior to joining, from ________________ until
________________;
3. I acknowledge that LizardBear Tasking Inc. has requested me to submit the Certificate of
Withholding Taxes on Compensation (BIR Form 2316) from my previous employer but I have
been unable to submit/have submitted late the BIR Form;
4. I further acknowledge that my failure to submit BIR Form 2316 to LizardBear Tasking Inc. will
not allow LizardBear Tasking Inc. to properly and correctly annualize the tax computation of
my total compensation income for this year and hence, LizardBear Tasking Inc. will have to
base its tax computation of my compensation for the year-end 2014 solely on the earning I
received from LizardBear Tasking Inc.;
5. In view of the foregoing, I hereby assume full responsibility for any tax excess or deficit that may
arise from the computation of my total annual taxable compensation and tax due as a result of or
in connection with my failure to submit the required BIR Form 2316 to LizardBear Tasking
Inc. and I hereby waive any claim or responsibility of LizardBear Tasking Inc. and agree to
hold LizardBear Tasking Inc. free and harmless from and for any responsibility arising from
the foregoing circumstances.

Executed this __________day of _______________2015 at _______________City, Philippines.

________________________
Signature over printed name

Signed in the presence of:

____________________________ ______________________________
Signature over printed name Signature over printed name

17th-19th Floors, Twenty-Four Seven McKinley Building, 24th St. and 7th Ave. Fort Bonifacio, Taguig City
Contact Nos. 0917-818-8891/ 02-978-2400

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