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13 Date of Birth (MM/DD/YYYY) 14 Zip Code 15 Telephone Number 16 Date of Birth (MM/DD/YYYY) 17 Zip Code 18 Telephone Number
I declare under penalties of perjury, that this return 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 the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.
42
Taxpayer/Authorized Representative/Accredited Tax Agent Title/Position of Signatory TIN of Signatory
Signature Over Printed Name
Tax Agent Acc. No./Atty's Roll No. (if applicable) Date of Issuance Date of Expiry
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
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BIR FORM 1701Q (ENCS)-PAGE 2
TAX TABLE
If TAXABLE INCOME is: TAX DUE is:
Not over P 10,000 5%
Over P 10,000 but not over P 30,000 P 500 + 10% of the excess over P 10,000
Over P 30,000 but not over P 70,000 P 2,500 + 15% of the excess over P 30,000
Over P 70,000 but not over P 140,000 P 8,500 + 20% of the excess over P 70,000
Over P 140,000 but not over P 250,000 P 22,500 + 25% of the excess over P 140,000
Over P 250,000 but not over P 500,000 P 50,000 + 30% of the excess over P 250,000
Over P 500,000 P 125,000 + 32% of the excess over P 500,000