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Republic of the Philippines
JULY 2016
VERSION
Department of Finance BUREAU OF INTERNAL REVENUE Quezon City
SWORN APPLICATION FOR TAX CLEARANCE (To be accomplished by Individual Taxpayer Securing Tax Clearance for Bidding)
I, _________________________________________________, Filipino/_____________(indicate indicate nationality for non-Filipino citizenship), of legal age, single/married to_____________________________________, permanently residing at _______________________________ ______________________________ with Taxpayer Identification Number (TIN) _____________________________ _____, after having been duly sworn in accordance with with law hereby depose and and state:
1. That I am am the Owner/Proprietor/Proprietress Owner/Proprietor/Proprietress of ____________________________________________________________ with business address at _____________________________________________________________________________, with Telephone/Cellular Telephone/Cellular Phone No. _____ _________________and email address _______________________________; 2. That my business trade name has been duly registered with the Department of Trade and Industry on _____________________________ _ under DTI Registration Registration Certificate No. _________________________________; 3. That I registered my business with BIR under under Certificate of Registration No.______________________issued at Revenue District Office No. _____________ on ___________________________________________________; 4. That, I am am securing/applying for TAX TAX CLEARANCE, a pre-requisite for entering into any contract with the Government Agencies as required under Executive Order No. 398, and implemented by RR No. 3-2005, as amended ; 5.
That, the following following documents required in relation relation to the aforesaid aforesaid application are all all authentic and hereto hereto attached in compliance with the existing policy. a. Delinquency Verification Certificate Certificate issued by __________________________ on ________; b.Two (2) pieces of loose documentary documentary stamp tax tax worth P15.oo each; and c. Confirmation Receipt of Electronic payment of certification fee.
6. And that, to the best of my knowledge, I have satisfied satisfied with the prescribed criteria for the issuance of Tax Tax Clearance.
______________ _____________________ ______________ ______________ ______________ __________ ___ Signature over Printed Name of Applicant
SUBSCRIBED AND SWORN to before me this __________ day of ____________________________, ___ in _______________________________ . Applicant exhibited to me his/her Community Tax Certificate No. _________________issued at __________________________ on ______________ _____________.
Doc. No. __________ Page No. __________ Book No. _________ Series of __________ -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-. ! Affix ! ! P15.00 ! ! Documentary Stamp Tax ! !-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-!
________________________________________ Notary Public
