APPLICATION FOR ORIGINAL INCOME TAX HOLIDAY



ERD.2.F.001

REPUBLIC OF THE PHILIPPINES

Philippine Economic Zone Authority

APPLICATION FOR INCOME TAX HOLIDAY

(Availment of Income Tax Holiday Incentive)

For the taxable year ended ___________________

I. INFORMATION ABOUT THE APPLICANT

Name of Company :

Tax Identification No. (TIN) :

Official Address :

Telephone No. :

Authorized Representative :

Registration No :

Date of Registration :

Registered Activity :

Status (Please check) : _____ Pioneer _____ Non-Pioneer

_____ Expansion

Start of commercial operation (SCO):

Committed (Per RA/SA/PFS) :

Actual (as attested by Zone Administrator/

Manger and/or PEZA approved SCO

adjustment) :

Previous ITH applied

(indicate period, status :

approval no./date)

II. PERPORMANCE DATA FOR TAXABLE YEAR

Volume Amount

A. Export Sales ____________________ P

B. Less: Base figure* __________________ __________________

C. Incremental Sales* ___________________

D. Rate of Exemption (C/A x 100)* ___________________%

E. Taxable Income P ___________________

F. Tax Due (E x tax rate**) ___________________

G. Income not subject to tax (D x E)* ___________________

H. Estimated income tax holiday (D x F) ___________________

RA - Registration Agreement

SA - Supplemental Agreement

PFS- Project Feasibility Study/ies

*For expansion and new projects with base figure only

**Regular Corporate Income Tax Rate

NAME OF COMPANY: ______________________________________________________

III. CHECKLIST OF SUPPORTING DOCUMENTS

| |Documentary Requirements |Submitted |

|1 |Copy of complete Audited Financial Statements filed with the BIR (duly stamped “Received” by BIR) together | |

| |with the ff: | |

| |Segregated income statement per registered activity (if more than 1 registered activity) and/or interim | |

| |income statement, if availment is for less than the 12 month period, duly certified by responsible | |

| |official. For IT companies with multiple sites/locations, income statement should be segregated per | |

| |site/location indicating the number of seats for each location. | |

| |Breakdown/Details of other/miscellaneous income per project, if any (e.g., forex gain | |

| |[realized/unrealized], scrap sales, interest income, income from unregistered activity etc.) duly certified| |

| |by responsible official | |

|2 |Copy of complete Income Tax Return filed with the BIR (duly stamped “Received” by BIR) | |

|3 |Copy of Sales Summary with the following particulars: invoice no., date, volume/quantity, amount in US$ | |

| |and its peso equivalent, buyer/destination certified by responsible official (per activity if more than 1 | |

| |registered activity). Export and local sales should be segregated. | |

|4 |Duly notarized sworn statement as to the start of commercial operation signed by responsible official and | |

| |attested by Zone Manager | |

|5 |Photocopy of official receipt of application fee (PhP1,200) | |

Done in _______________________ this ___________ day of _______________, 20 ___.

___________________________________

Signature of Authorized Signatory

Printed Name: ____________________________

Designation/Position:__________________

REPUBLIC OF THE PHILIPPINES

________________________________) S.S.

________________________________)

SUBSCRIBED and SWORN to before me this _______ day of ____________________, 20____

In the City/Province of __________________. Affiant exhibited to me his/her Community tax No. _________________________ issued at ____________________ on _________, 20____

_____________________

NOTARY PUBLIC

Doc. No. _________ Until Dec. 31, 20_________

Page No._________ PTR No. _________________

Book No. ________ Issued at ________________

Series of _________ Issued on ________________

Application for Income Tax Holiday

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