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(To be filled up by the BIR) DLN: PSIC: Republika ng Pilipinas Kagawaran ng Pananalapi Kawanihan ng Rentas Internas Monthly Percentage Tax Return 3 For the month 4 Amended Return 5 BIR Form No. 2551M September 2005 (ENCS) Number of sheets attached Fill in all applicable spaces. Mark all appropriate boxes with an “X”. 1 2 For the Year ended (MM/YYYY) Calendar Fiscal 12 2012 (MM/YYYY) Background 01 2012 Yes No Part I 6 9 TIN Information Occupation Taxpayer's Name (For Individual)L
  (To be filled up by the BIR)DLN:PSIC:   Fill in all applicable spaces. Mark all appropriate boxes with an “X”. 1 For theCalendar Fiscal   3 For the month 4 Amended Return 5 Number of sheets attached 2 Year ended Part IB a c k g r o u n d I n f o r m a t i o n6 TIN 7 RDO Code 8 Line of Business/ Occupation 9 Taxpayer's Name (For Individual)Last Name, First Name, Middle Name/(For Non-individual) Registered Name 10 Telephone Number 11 Registered Address 12 Zip Code 13 Are ou availin of tax relief under Secial Lawor International Tax Treaty?YesNo If yes, specify Part IIC o m p u t a t i o n o f T a x Taxable Transaction/ A T CTaxable Amount Tax RateTax DueIndustry Classification 14 14 14C 14D 14E15 15 15C 15D 15E16 16 16C 16D 16E17 17 17C 17D 17E18 18 18C 18D 18E19 Total Tax Due 1920 Less: Tax Credits/Paments 20A Creditable Percentage Tax Withheld Per BIR Form No. 2307 (See Schedule 1) 2020B Tax Paid in Return Previously Filed, if this is an Amended Return 2021 Total Tax Credits/Payments (Sum of Items 20A & 20B) 2122 Tax Payable (Overpayment) (Item 19 less Item 21) 2223 Add: PenaltiesSurchargeInterestCompromise 232323 2324 Total Amount Payable/(Overpayment) (Sum of Items 22 and 23D) 24 If overpayment, mark one box only:To be Refunded To be issued a Tax Credit CertificateI declare, under the enalties of erur, that this return has been made in ood faith, verified b me, and to the best of m knowlede, and belief,is true and correct, ursuant to the rovisions of the National Internal Revenue Code, as amended, and the reulations issued under authorit thereof. 2526 PROP.Tax Agent Acc. No./Atty's Roll No.(if applicable) Part III Details of PaymentDrawee Bank/ DateParticulars Agency Number MMDD YYYY Amount 27 Cash/Bank 27A27B 27C 27 Debit Memo 28 Check 28A28B 28C 28D 29 Tax Debit 29A 29B 29C Memo 30 Others 30A30B 30C 30D Machine Validation/Revenue Official Receipt Details (If not filed with an Authorized Agent Bank) Treasurer/Assistant TreasurerAuthorized Representative/Taxpayer (Signature Over Printed Name)(Signature Over Printed Name)President/Vice President/Principal Officer/Accredited Tax Agent/  (RO's SignaturStamp ofBank Teller's Ini Title/Position of SignatoryTIN of SignatoryTitle/Position of SignatoryDate of IssuanceDate of ExpiryTIN of Signatory Receiving Office/ and Date of Rec   01 20120082600003% 2551 September 2005 (ENCS) Monthly PercentageTax Return BIR Form No. Republika ng PilipinasKagawaran ng Pananalapi Kawanihan ng Rentas InternasYes No (MM/YYYY) 12 2012 (MM/YYYY)   e/  tial)   AABeipt 0   
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