BIR Form No.0605 Page 1 of 1 BIR Form No. Republika ng Pilipinas Kagawaran ng Pananalapi Kawanihan ng Rentas Internas Payment Form 0605 September 2003(ENCS) 1 For the Calendar Fiscal 3 Quarter 4 Due Date (MM/DD/YYYY) 5 No. of Sheets Attached 6 ATC ATC 2 Year Ended (MM/YYYY) 1st 2nd 3rd 4th 01 30 2018 0 MC180 01 - January 2018 7 Return Period (MM / DD / YYYY) 01 30 2018 8 Tax Tax Type RF Part I Background Information 9 Taxpayer Identification No. 10 RDO Code 11 Taxpayer Classification 12 Line of Business/Occupation 300 099 830 000 081 I N FOOD SERVICES 13 Taxpayer's Name (Last Name, First Name, Middle Name for Individuals) /(Registered Name for Non-Individuals) 14 Telephone Number PURGATORIO, SHARON, MAMUGAY 09999722933 15 Registered Address 16 Zip Code SHALOM CENTER BLDG., OSMENA BLVD., CEBU CITY 6000 17 Manner of Payment 18 Type of Payment Voluntary Payment Per Audit/Delinquent Account Installment Self-Assessment Preliminary/Final Assess/Deficiency Tax No. of Installment Penalties Accounts Receivable/Delinquent Account Partial Payment Tax Deposit/Advance Payment Full Payment Income Tax Second Installment(Individual) Others(Specify) REGISTRATION FEE Part II Computation of Tax 19 Basic Tax/Deposit/Advance Payment 19 500.00 20 Add: Penalties Surcharge Interest Compromise 20A 0.00 20B 0.00 20C 0.00 20D 0.00 21 Total Amount Payable(Sum of Items 19 & 20D) 21 500.00 Pre-approved by Investigating Office Not approved by Investigating Office For Payment of Deficiency Taxes For Voluntary Payment Stamp of Receiving -- Office From Audit/Investigation/ and Date of Receipt Deliquent Account I declare, under the penalties of perjury, that this document has been made in good faith, verified by me, and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of National APPROVED BY: Internal Revenue Code, as amended, and the regulations issued under authority thereof. 22B____________________ 22A__________________________________________ ________________ Signature Over Printed Name of Signature over Printed Name of Taxpayer/Authorized Representative Title/Position of Signatory Head of Office Machine Validation/Revenue Official Receipt Details (If not filed with the bank) Taxpayer Classification: I - Individual N - Non-Individual file:///C:/Users/alfx216/AppData/Local/Temp/%7BC66626E0-8E02-40EC-8AEB-918... 1/19/2018