02/19/2014***14:OS:O50420120301631

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BIR Form No.
i..
Kagawaran ng Pananalapi
Republika ng Pilipinas
Certificate of Compensation
2316
e
.
Kawanihan ng Rentas Internas
Payment/Tax Withheld
For Compensation Payment With or Without Tax Withheld July 2008 (ENCS)
Fill in all aDolicable soaces. Mark all aoorooriate boxes with an "X"
I For the Year
I
2 For the Period
R2
(
yYyy
)
20131 From (MM/DO) To (MM/DO)
Part I Employee Information Part IV-B
Details of Compensation Income and Tax Withheld from Present Employer
3 Taxpayer
1 ~~ I F 1
Amount
Identification No. i i A. NONTAXABLE/EXEMPT COMPENSATION INCOME

32Basic Salary/ 32

I
_

4 Employee's Name (Last Name, First Name, Middle Name) 5 R_D_O Code
' r-RI

Ll
_
Statutory Minimum Wage
6 Registered Address 6A Zip Code
.
Minimum Wage Earner (MWE)
I
Vi P 33 Holiday Pay (MWE) 33
Overtime Pay (MWE) 34

35 Night Shift Differential (MWE) 35

36 Hazard Pay (MWE) 36
61 1 3 Local Home Address 6C Zip Code ____________
1 mik'
;r M7 wt(
!? 3/ i O
I
6DForeign Address
JL
6E Zip Code
7 Date of Birth (MMIDD/YYYY
_
8 Tehone Number
________________________
______________________
_ 1
37 1 3th Month Pay 37
and Other Benefits
9,650.00
9 Exemption Status
[ -I_i_I
Single Married
___
9A Is the wife claigjhe additional exemption for qualified dependent children?
iiefL L C) W A N cE 51000.00
I
L__i
Yes No

39 SSS, GSIS, PHIC& Pag-ibig 39
__
27,732.00
-
1 0 Name of Qualified Dependent Children 1 1 Date of Birth (MM/DDIYYYY)
Contribns,&Unbon0s

(Employee share only)
40 Salaries & Other Forms 40
Compensation ? ERA I_24_000._00
1 21
1 2 Statutory Minimum Wage rate per day
1 3 Statutory Minimum Wage rate per month 1 3 41 Total Non-Taxable/Exempt 41 I
8 5382. 00 Compensation Income
I
1 4
J
Minimum Wage Earner whose compensation is exempt from
withholding tax and not subject _to income tax B. TAXABLE COMPENSATION INCOME
REGULAR
42 Basic Salary 42
[ _
23 1, 279. 67
Representation 43
r
Transportation 44

i
_
Part_II_ Employer _Information _(Present)
1 5 Taxpayer_
_________
j_ --I.- IdentificationNo.P

9S8_
li_. Employer's Name
P1
flFPEDflT)TSI flN_
fly
URORL\FLEMFNTAR' _
1 7 Registered Address 17A Zip Code
_
_
PL
SAN LUIS, AURORA j _ T
3.01
45Cost of Living AlInwnr.a 45

46 Fixed Housing Allowance 46
-. _
Main_ Employer _flSecondary _Employer
__
Part _III _Employer _Information _(Previous)
1 8 Taxpayer
II
T_ j
Identification No.
P
,
.
1 9 Employer's _Name 47 Others(Specify)
47A
]
47A{
_
20 Registered Address - 20A Zip_ 47B
T -= -1
47B[ __
-
-I
I L...._ I .j -.. - ... -
I SUPPLEMENTARY
1 48 Commission 48
16, 661. 67

Part IV-A Summary
21 Gross Compensation Income from 21
Present Employer (Item 41 plus Item 55)
22 Less: Total Non-Taxable! 22
49 Profit Sharing 49
Exempt (Item 41 )
231, 27 9. 67
23 Taxable Compensation Income 23

from Present Employer (Item (55) 50 Fees Including Director's 50
Iii1 24 Add: Taxable Compensation 24 Fees
Income from Previous Employer
25 Gross Taxable 25 231, 279. 67
Taxable 1 3th Month Pay 51
I 0. 00
Compensation Income and Other Benefits
(_
75 .
)(_ r
26 Less: Total Exemptions 26
52 Hazard Pay 52
27 Less: Premium Paid on Health 27
0. 00 and/or Hospital Insurance (it applicable)
28 Net Taxable 28
53 Overtime Pay 53
1S6, 279 . 67
Compensation Income
29 Tax Due 29 54 Others (Specify)
30 Amount of Taxes Withheld
MA

54
26, :;'i;. ?2
30A Present Employer 3OA
,S69. _92
3OB Previous Employer
30B

54B 54
_
31Total Amount of Taxes Withfleld 31
55 Total Taxable Compensation 55
[ As adjusted
26__S69.
i9. income 2fl_ 7
We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by us, and to the best of our knowledge and belief. is true and correct
pursuant to the and the regulations issued una!hiritY.Jie,r1 of.
1 :1 1 ]
56 Date Signed
.-

________ ____
Present Employer!
AuthQ(
dzed Agent Signature Over Printed Name
. CONFORME:-o
57 -.-:R L_INIA ..A ._VAL_INO Date Signed
CTCNo. Employee Signature Over Printed Name Amount Paid
uii-nivayoe
' ' (
,
V I
Placeoflssuo
_ rt/1 -L4\Ptj'
Dateoflssue
j .01 I - o7iI
--------.. To_be accomplis4jider substituted _filing
I declare, under the penalties of perjury that I am qualified under substituted filing of I declare, under the penalties ofperjury, that the Information herein stated are reported
under BIR Form No. 1 604CF which has been filed with the Bureau of internal Revenue. Income Tax Returns (BIR Form No. 1 700), since I received purely compensation Income
.
from only one employer in the Phils. for the calendar year: that taxes have been
MI CHELLE M. VAL.ENZUELA
correctly withheld by my employer (tax due equals tax withheld): that the BIR Form
58 No. 1 604CF filed by my employer to the BIR shall constitute as my income tax return:
and that BIR Form o9,26 shall serve tbe sa1 purpose as if BIR Form No. 1 700
had been filed pursuafrs as amended.
Present Employer/Authorized Agent Signature Over Printed Name
(Head of Accounting/ Human Resource or Authorized Representative)
59 -,
Employee Signature Over Printed Name
- - - - ... -...-... -I 1 ,.,.,,, .,_ rif, r ..
42
20J 727. 84
r,J1 c?/201 4***1 : 57: 1 2 042 01 2 4436223
DLII:
0
BIR Form No
Republika ng Pilipinas
Certificate of Compensation

Kagawaran ng Pananalapi
, Kawanihan ng Rentas tnternas
Payment/Tax Withheld
2316
For Compensation Payment With or Without Tax Withheld

July 2008 (ENCS)

Fijiin
all aDDlicable sDaces. Mark all aDDrooriate
boxes with an

(
YYYy
)
_gq4
From (MM/DD) LI iI I I E.i
To (MM/DD)
1 I1 I Forthe Year
2 ForthePenod
Part I
Employee Information
Part IV-B
Details of Compensation Income and
Tax Withheld from Present Employer
Amount
3 Taxpayer
p
LIE
J[03iIF I L_I.LII1
A.
NONTAXABLEJEXEMPT COMPENSATION INCOME
Identification No
E
(Last Name, First Name, Mid le Name)
5 ROCCode
LINDA
32Basic Salary!
32
MA
Statutory Minimum Wage
6Registeredre
6A ZiCode
Minimum Wage Earner (MWE)
[iLI ] 33Holiday Pay (MWE)
33
r1
I
66
Local Home Address
6C Zip Code
I 7 qk
34Overtime Pay (MWE)
34
_L tAy
6D ForqLqn Address
_______ ________6E
Zip Code
] LI I I I I I I I I I I I I I 1
35
Night Shift Differential (MWE) 35
Number 36 Hazard Pay (MWE)
36
7Dateof Birth (MM!DD/YYYYI JT

I
37 1 3th Month Pay
26,302-00.
9 Exemption Status
and Other Benefits
rii
Single
F=x
Married
L]
Yes

exemption fgglifled dependent children?

51 000.00
9A is the wife claiming the additional
No
1 0 Name of Qualified Dependent
Children
1 1 Date of Birth (MM/DDIYYYY) rill b. 10
39 SSS, GSIS, PHIC & Pag-ibig 39

____
Contributions, & Union Dues
rst (Employee share only)
I A t. '"
------- -
H____
40 Salaries & Other Fos OERA
40
24, 000. 0= 0
1 2 Statutory Minimum Wage rate per day
1 2
mpensation
IIIIIII1
1 3 Statutory Minimum Wage rate per month
1 3F
_________
41
Compensation Income
Total Non-Taxable/Exempt 41
r ' 98 1
1 4
Minimum Wage Earner whose compensation is exempt from
withholding tax and not subject to income tax

B. TAXABLE COMPENSATION INCOME

Em ployer
--'' REGULAR -
Part II
Employer unTormauo" rrueuu
1 5 Taxpayer
TTJ 1 1 TT
42
____________________ _____________________________
Basic Salary
Identification No ___________________
16Em lo ers Name
1 1 -1 DEPED-DIVISION OF AURORA-ELEMENT'AR
43Representation
1 7Re istered Address
hA Zip Code
44 Transportation
SAN LUIS, AUFUHA
- 1 1 5A.. '1 ' fliS'nndsrv Emolover
45 Cost of Living Allowance
Part iii
Employer
1 8 Taxpayer
Identification No.
0.
1 yrsName
20 Rered Address
Part IV-A
21 Gross Compensation income from
Present Employer (Item 41 plus item 5!
22 Less: Total Non-Taxable!
Exempt (Item 41 )
23 Taxable Compensation income
from Present Employer (item (55)
24Add: Taxable Compensation
Income from Previous Employer
25 Gross Taxable
Compensation Income
26Less: Total Exemptions
27 Less: Premium Paid on Health
and/or Hospital inu,aflce (ifapplicable)
28 Net Taxable
('.nmnAnsation Income Income
47 Otherspcify)
]4 T AL__________
L____ _J
SUPPLEMENTARY
48 Commission 48 r
I
21
22
23
24
25
26
27
28
cEiCDi7cC). kiLl
49Profit Sharing
50 Fees Including Director's
Fees
51 Taxable 1 3th Month Pay
and Other Benefits
52 Hazard Pay
53 Overtime Pay
f3CL 1 9fTh 1 6
206 .' 7. 4
201 727.
1 25 000. 00
00
8 1 77 4
Information (Previous )

Fixed Housing Allowance

20A Zip Code
P1
49
5O
EL.
51

52r
53 L
EL.
-.
J
29Tax Due 29
57
54 Others (Specify)

84 5
1

30 Amount of Taxes Withheld

57
MB

30A Present Employer
As adjusted
31
f
84 5. j7 :i
-
ILIncome

2O6 727. 84
T otal T axable Compensation 55
54B[
309Previous Employer 30B

____ ____
31 Total Amount of Taxes Withheld
We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the
and the regulations issued
2O4--------
DateSigned
I I
56
___ /iitzed Agent Signature Over jje Name
__________________________
Present Em
MA LINDA U. AI3ERO
Date Signed f
1J3lJ 2Ol '7
CONFORME
57
Th -- -
______________
I
Amount Paid
crc No.

Empioyature Over P
f Employ**
7
Plac e uf issu(,
Date of issue
r_:::_.IIIIIIIIIJ
_ ________
7
No.1 604CF declare, under the penalties of peu that I am qualified under substituted filing of
ne employer rithe Phils for the calendar year;that taxes have been
I declare, under the
stated are retxrted
Returns (BIR Form No 1 700), since I received puroly compensation income
under BIR Form No. 1 604CF which has been filed with the Bureau of Intemal Revenue
P1 1 CHELLE P1 .
VALENZUELA

hheld by my employer (tax due equals tax withheid), that the SIR Form
58

filed by my employer to the SIR shall constitute as my income tax return;

Present Employer/Autho.iz.j Agent Signature Over Printed Name

(Head of Accounting/ Human Resource orAuthorized Representative)

had
Form No. 231 6 shall serve the same
purpose as if SIR Form 'k 1 70

..
as smando -
59
- I-
or' incluiri
es c all
-