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    Annex B-2

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    Von Virchel Valles
    This document is a sworn declaration from an individual taxpayer for income received from the LGU-City of San Fernando, Pampanga. It details that the taxpayer derives income only from this lone payor. It further specifies that the taxpayer's gross receipts will not exceed 250,000 pesos for the current year. The taxpayer then selects either the graduated income tax rates or an 8% income tax rate on gross receipts. It acknowledges the tax obligations and withholding requirements that correspond to the selected tax rate.

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    Annex B-2

    Uploaded by

    Von Virchel Valles
    348 views1 page
    This document is a sworn declaration from an individual taxpayer for income received from the LGU-City of San Fernando, Pampanga. It details that the taxpayer derives income only from this lone payor. It further specifies that the taxpayer's gross receipts will not exceed 250,000 pesos for the current year. The taxpayer then selects either the graduated income tax rates or an 8% income tax rate on gross receipts. It acknowledges the tax obligations and withholding requirements that correspond to the selected tax rate.

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    This document is a sworn declaration from an individual taxpayer for income received from the LGU-City of San Fernando, Pampanga. It details that the taxpayer derives income only from this lone payor. It further specifies that the taxpayer's gross receipts will not exceed 250,000 pesos for the current year. The taxpayer then selects either the graduated income tax rates or an 8% income tax rate on gross receipts. It acknowledges the tax obligations and withholding requirements that correspond to the selected tax rate.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    348 views1 page

    Annex B-2

    Uploaded by

    Von Virchel Valles
    This document is a sworn declaration from an individual taxpayer for income received from the LGU-City of San Fernando, Pampanga. It details that the taxpayer derives income only from this lone payor. It further specifies that the taxpayer's gross receipts will not exceed 250,000 pesos for the current year. The taxpayer then selects either the graduated income tax rates or an 8% income tax rate on gross receipts. It acknowledges the tax obligations and withholding requirements that correspond to the selected tax rate.

    Copyright:

    © All Rights Reserved
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    of 1

    ANNEX “B-2”

    INCOME PAYEE’S SWORN DECLARATION OF GROSS RECEIPTS/SALES


    (For Self-Employed and/or Engaged in the Practice of Profession with Lone Income Payor)

    I, _________________________________________________, ___________________________, of legal age, single/ married to


    (Name) (Citizenship)
    _____________________________________________________ permanently residing at _________________________________
    (Name of Spouse)
    ____________________________________________________________________________________________________________ with
    (Address)
    Taxpayer Identification Number (TIN) __________________________________, after having been duly sworn in accordance with law

    hereby depose and state:

    1. That I derived my PROFESSIONAL income only from LGU- City of San Fernando, Pampanga with Taxpayer
    (business/professional) (Name of Lone Payor)
    Identification Number 002-054-916 and business address at A. Consunji St. Brgy Sto. Rosario, City of San Fernando,
    Pampanga

    That for the current year ________, my gross receipts will not exceed Two Hundred Fifty Thousand Pesos (₱250,000.00) and
    that I am registered as a non-VAT taxpayer; that whatever is the amount of income received, I will comply with the
    requirement to file my Income Tax Return on the prescribed due date. For this purpose, I opt to avail of either one of the
    following:

     Graduated Income Tax Rates under Section 24(A)(2)(a) of the Tax Code, as amended, based on the taxable
    income. With this selection, I acknowledge that I am subject to 0% income tax, thus, not subject to
    creditable withholding tax; subject to percentage tax, if applicable, and will file the required percentage tax
    returns or subject to withholding percentage tax, in case of government money payments.

     Eight Percent (8%) income tax rate under Section 24(A)(2)(b) of the Tax Code, as amended, based on
    gross receipts/sales and other non-operating income - with this selection, I understand that this is in lieu of
    the graduated income tax rates and the Percentage Tax under Section 116 of the Tax Code, as amended;
    thus, no withholding tax shall be made;

    2. That based on my selection above, if my gross sales/receipts and other non-operating income exceeds ₱250,000.00 but not
    over ₱3,000,000.00, my afore-stated lone income payor shall automatically withhold the prescribed rate of withholding tax:

    a. In case of Graduated Income Tax Rates, I acknowledge that aside from income tax, I am subject to
    business tax (Percentage Tax, if applicable) and creditable withholding of income in excess of
    P250,000.00, and business tax withholding, if any, are applicable on the entire income payment; OR

    b. In case of Eight Percent (8%) income tax rate, I acknowledge that I am only subject to income tax and
    thus, to the creditable withholding income tax in excess of P250,000.00;

    3. That I duly execute this SWORN DECLARATION in compliance with the requirement prescribed under Section ____ of
    Revenue Regulations No. ________;

    4. That I declare, under the penalties of perjury, that this declaration has been made in good faith, and to the best of my
    knowledge and belief to be true and correct.

    _____________________________________________
    Signature over Printed Name of Individual Taxpayer

    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 withholding agent/lone payor)

    Date Received: __________________ Received by:


    (MM-DD-YYYY-00001)
    MARIA GISEL P. RIVERA
    Signature over Printed Name of the Withholding Agent/Payor or Authorized Officer

    CITY ACCOUNTANT
    Designation/Position of Authorized Officer

    LGU- CITY OF SAN FERNANDO


    Name of Withholding Agent/Lone Payor

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