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    Annex C RR 11-2018 XXXX

    Uploaded by

    Moi Escalante
    This document is an income payor's sworn declaration containing information about income payees where no withholding tax is deducted from their income payments. It states that there are [number] payees where no withholding is made for expanded tax or VAT/percentage tax. It also states that there are [number] individual payees subject to a 5% withholding tax rate and [number] non-individual payees subject to the same due to anticipated gross receipts being below certain thresholds. Lists of the relevant payees are attached. The declaration is submitted in compliance with revenue regulations and made in good faith under penalty of perjury.

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    Annex C RR 11-2018 XXXX

    Uploaded by

    Moi Escalante
    117 views2 pages
    This document is an income payor's sworn declaration containing information about income payees where no withholding tax is deducted from their income payments. It states that there are [number] payees where no withholding is made for expanded tax or VAT/percentage tax. It also states that there are [number] individual payees subject to a 5% withholding tax rate and [number] non-individual payees subject to the same due to anticipated gross receipts being below certain thresholds. Lists of the relevant payees are attached. The declaration is submitted in compliance with revenue regulations and made in good faith under penalty of perjury.

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    Annex C RR 11-2018 Xxxx

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    This document is an income payor's sworn declaration containing information about income payees where no withholding tax is deducted from their income payments. It states that there are [number] payees where no withholding is made for expanded tax or VAT/percentage tax. It also states that there are [number] individual payees subject to a 5% withholding tax rate and [number] non-individual payees subject to the same due to anticipated gross receipts being below certain thresholds. Lists of the relevant payees are attached. The declaration is submitted in compliance with revenue regulations and made in good faith under penalty of perjury.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    117 views2 pages

    Annex C RR 11-2018 XXXX

    Uploaded by

    Moi Escalante
    This document is an income payor's sworn declaration containing information about income payees where no withholding tax is deducted from their income payments. It states that there are [number] payees where no withholding is made for expanded tax or VAT/percentage tax. It also states that there are [number] individual payees subject to a 5% withholding tax rate and [number] non-individual payees subject to the same due to anticipated gross receipts being below certain thresholds. Lists of the relevant payees are attached. The declaration is submitted in compliance with revenue regulations and made in good faith under penalty of perjury.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Annex “C”

    INCOME PAYOR/WITHHOLDING AGENT’S SWORN DECLARATION

    I, _________________________________________________, ____________________________, of legal age, single/


    (Name of Proprietor/Authorized Officer) (Citizenship)
    married, the designated _______________________________________ of _________________________________
    (Designation/Position) (Name of Withholding Agent)
    with Taxpayer Identification Number (TIN) __________________________________, after having been duly sworn in

    accordance with law hereby depose and state:

    1. That there are ____________ income payees (self-employed individuals) where no withholding is made, consisting
    of the following:

    Type of withholding NOT withheld Number of income payees


    Expanded WT only
    WT on VAT/Percentage Tax only
    Both expanded and VAT/Percentage tax
    Total

    2. That the above payees where no withholding tax is deducted from their income payment/s have executed the
    required Income Payee’s Sworn Declarations on the amount of gross receipts which they expect to receive for the
    year ______________, and these sworn declarations are duly received together with copies of their Certificate of
    Registration (COR);

    3. That there are _________ individual income payees withheld five percent (5%) withholding tax rate due to their
    submission of “Payee’s Sworn Declaration of Gross Receipts/Sales” stating that their gross receipts/sales shall not
    exceed ₱3,000,000 (₱3M) for the current year, while ______ non-individual payees submitted “Income Payee’s
    Sworn Declaration” stating that their gross receipts/sales shall not exceed P720,000 for the current year;

    4. That I am attaching with this sworn declaration the list of individual payees subject of items 1 and 2 above consisting
    of ________ number of pagers, the list of individual payees subject of item 3 above with ____________ number of
    pages, and the list of non-individual payees subject also of item 3 above with _________ number of pages;

    5. That the submission is in compliance with the requirements prescribed under Section _________ of Revenue
    Regulations No. ___________.

    6. That this declaration, including the attached list/s, is made in good faith, to the best of my knowledge and belief, to
    be true and correct, under the penalties of perjury.

    IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________, 20___ at ___________, Philippines

    __________________________________________________
    Signature over Printed Name of Withholding Agent/Authorized Officer of the Withholding
    Agent

    __________________________________________________
    Designation/Position if Authorized Officer

    __________________________________________________
    Name of Withholding Agent/Lone Payor

    SUBSCRIBED AND SWORN to before me this _____ day of ____________, 20___ in


    _______________________________. Applicant exhibited to me his/her ___________________________issued at
    _______________________ on _________________________.
    (Government Issued ID and No.)

    NOTARY PUBLIC
    Doc. No.: __________
    Page No.: __________
    Book No.: __________
    Series of ___________

    Affix ₱30.00
    Documentary
    Stamp Tax

    (To be filled-out by the concerned Revenue Officer)

    Date Received: __________________ Received by:


    (MM-DD-YYYY-00001)
    __________________________________________________________
    Signature over Printed Name of Revenue Officer

    __________________________________________________________
    Designation/Position of Revenue Officer
    __________________________________________________________
    RDO No.

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