Quarterly Income Tax Return: (YYYY) 1st 2nd 3rd Yes No
Quarterly Income Tax Return: (YYYY) 1st 2nd 3rd Yes No
Quarterly Income Tax Return: (YYYY) 1st 2nd 3rd Yes No
1701Q
Page 1 of 1
> PSIC:
(YYYY)
1st
2014
2nd
1701Q
July 2008(ENCS)
4 No. of sheet/s
Amended Return?
3rd
Yes
Taxpayer/Filer
236
299
219
Spouse
6 RDO 024
000
7 TIN
8 RDO
Code
000
Code
attached?
No
Background Information
Part I
5 TIN
> PSIC:
BIR Form No.
Quarterly Income
Tax Return
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Taxpayer's Name (Last Name, First Name, Middle Name) (Estates & Trusts)
10
11
12
Registered Address
Registered Address
19
05
14
ZIP Code
Line of
Business/Occupation
20 ATC
LEASING
23
Tel. No.
IIO11
Compensation
II012
Business
II013
Mixed Income
21
24
40% Optional Standard Deduction
18
Tel. No.
22 ATC
II011
Compensation
II012
Business
II013
Mixed Income
Yes
No
Computation of Tax
Sales/Revenues/Receipts/Fees
Add: Amount Rec'd by a partner from General Professional Partnership
(except loans)
Total
Less: Cost of Sales/Service
Gross Income from Operation
Add: Other Income
Total Gross Income
Less: Deductions
Taxable Income This Quarter
Add: Taxable Income Previous Quarter(s)
Taxable Income To Date
Tax Due
Taxpayer/Filer
26A
27A
28A
29A
30A
31A
32A
33A
34A
35A
36A
37A
Spouse
26B
27B
81,000.00
0.00
0.00
0.00
28B
29B
30B
31B
32B
33B
34B
35B
36B
37B
81,000.00
0.00
81,000.00
0.00
81,000.00
32,400.00
48,600.00
0.00
48,600.00
5,290.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Surcharge
Interest
Compromise
41
ZIP Code
Method of Deduction
Itemized Deduction
39
40
Line of
Business/Occupation
Are you availing of tax relief under Special Law or International Tax Treaty?
Part II
26
27
28
29
30
31
32
33
34
35
36
37
38
17
2931112
Method of Deduction
Itemized Deduction
25
15
1441
1966
38A
38C
38E
38G
38I
38K
38M
39A
40A
40C
40E
40G
41A
38B
38D
38F
38H
38J
38L
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
38N
39B
40B
40D
40F
40H
41B
0.00
5,290.00
1,322.50
11.76
1,500.00
2,834.26
8,124.26
41C
0.00
0.00
0.00
0.00
0.00
0.00
0.00
8,124.26
file:///C:/Users/Alex/AppData/Local/Temp/%7BC8E2623C-5A89-4BF1-8682-9D473C4...
11/20/2014