Republic of the Philippines

Department of Finance
For BIR BCS/ Bureau of Internal Revenue
Use Only
BIR Form No. Item:
Certificate of Creditable Tax
2307
January 2018 (ENCS)
Withheld at Source
Fill in all applicable spaces. Mark all appropriate boxes with an "X".

1 For the Period From 0 4 01 2 0 2 0 (MM/DD/YYYY) To 0 4 3 0 20 20 (MM/DD/YYYY)

Part I – Payee Information

2 Taxpayer Identification Number (TIN) 9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3

3 Payee’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

REYES, ANELYN
4 Registered Address 4A ZIP Code

4114
5 Foreign Address, if applicable

Part II – Payor Information

6 Taxpayer Identification Number (TIN) 008 - 323 - 736 - 00000

7 Payor’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

DASMARINAS CITY MEDICAL CENTER INC.

8 Registered Address 8A ZIP Code

DCMCI BLDG. SALAWAG CROSSING CITY OF DASMARINAS CAVITE 4114

Part III – Details of Monthly Income Payments and Taxes Withheld
AMOUNT OF INCOME PAYMENTS
Income Payments Subject to Expanded Tax Withheld for the
ATC 1st Month of the 2nd Month of the 3rd Month of the
Withholding Tax Total Quarter
Quarter Quarter Quarter
Payments for medical/dental/veterinary services WI150 16,842.10 - - 16,842.10 1,684.21
- -

Total 1,684.21
Money Payments Subject to Withholding
of Business Tax (Government & Private)

Total

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 provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, we give our consent to
the processing of our information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

CHERRIE ANN YU - ILAGAN, MD

FINANCE OFFICER / 223-944-918-0000
Signature over Printed Name of Payor/Payor’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
CONFORME:

REYES, ANELYN
9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3
Signature over Printed Name of Payee/Payee’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)
 Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Creditable Tax
2307
January 2018 (ENCS)
Withheld at Source 2307 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".

1 For the Period From 0 5 01 2 0 2 0 (MM/DD/YYYY) To 0 5 3 1 20 20 (MM/DD/YYYY)

Part I – Payee Information

2 Taxpayer Identification Number (TIN) 9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3

3 Payee’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

REYES, ANELYN
4 Registered Address 4A ZIP Code

4114
5 Foreign Address, if applicable

Part II – Payor Information

6 Taxpayer Identification Number (TIN) 008 - 323 - 736 - 00000

7 Payor’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

DASMARINAS CITY MEDICAL CENTER INC.

8 Registered Address 8A ZIP Code

DCMCI BLDG. SALAWAG CROSSING CITY OF DASMARINAS CAVITE 4114

Part III – Details of Monthly Income Payments and Taxes Withheld
AMOUNT OF INCOME PAYMENTS
Income Payments Subject to Expanded Tax Withheld for the
ATC 1st Month of the 2nd Month of the 3rd Month of the
Withholding Tax Total Quarter
Quarter Quarter Quarter
Payments for medical/dental/veterinary services WI150 - 1,000.00 - 1,000.00 100.00
- -

Total 100.00
Money Payments Subject to Withholding
of Business Tax (Government & Private)

Total

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 provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, we give our consent to
the processing of our information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

CHERRIE ANN YU - ILAGAN, MD

FINANCE OFFICER / 223-944-918-0000
Signature over Printed Name of Payor/Payor’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
CONFORME:

REYES, ANELYN
9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3
Signature over Printed Name of Payee/Payee’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)
 Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Creditable Tax
2307
January 2018 (ENCS)
Withheld at Source 2307 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".

1 For the Period From 0 9 01 2 0 2 0 (MM/DD/YYYY) To 0 9 3 0 20 20 (MM/DD/YYYY)

Part I – Payee Information

2 Taxpayer Identification Number (TIN) 9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3

3 Payee’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

REYES, ANELYN
4 Registered Address 4A ZIP Code

4114
5 Foreign Address, if applicable

Part II – Payor Information

6 Taxpayer Identification Number (TIN) 008 - 323 - 736 - 00000

7 Payor’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

DASMARINAS CITY MEDICAL CENTER INC.

8 Registered Address 8A ZIP Code

DCMCI BLDG. SALAWAG CROSSING CITY OF DASMARINAS CAVITE 4114

Part III – Details of Monthly Income Payments and Taxes Withheld
AMOUNT OF INCOME PAYMENTS
Income Payments Subject to Expanded Tax Withheld for the
ATC 1st Month of the 2nd Month of the 3rd Month of the
Withholding Tax Total Quarter
Quarter Quarter Quarter
Payments for medical/dental/veterinary services WI150 - - 101,731.03 101,731.03 10,173.10
Professional (Lawyers, CPAs, Engineers, etc.) WI011 57,894.73 57,894.73 5,789.47

Total 15,962.58
Money Payments Subject to Withholding
of Business Tax (Government & Private)

Total

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 provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, we give our consent to
the processing of our information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

ENRICO P. EVANGELISTA, MD, DPBA, MHA

FINANCE OFFICER / 206-449-940-0000
Signature over Printed Name of Payor/Payor’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
CONFORME:

REYES, ANELYN
9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3
Signature over Printed Name of Payee/Payee’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)
 Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Creditable Tax
2307
January 2018 (ENCS)
Withheld at Source 2307 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".

1 For the Period From 1 0 01 2 0 2 0 (MM/DD/YYYY) To 1 0 3 1 20 20 (MM/DD/YYYY)

Part I – Payee Information

2 Taxpayer Identification Number (TIN) 9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3

3 Payee’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

REYES, ANELYN
4 Registered Address 4A ZIP Code

4114
5 Foreign Address, if applicable

Part II – Payor Information

6 Taxpayer Identification Number (TIN) 008 - 323 - 736 - 00000

7 Payor’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

DASMARINAS CITY MEDICAL CENTER INC.

8 Registered Address 8A ZIP Code

DCMCI BLDG. SALAWAG CROSSING CITY OF DASMARINAS CAVITE 4114

Part III – Details of Monthly Income Payments and Taxes Withheld
AMOUNT OF INCOME PAYMENTS
Income Payments Subject to Expanded Tax Withheld for the
ATC 1st Month of the 2nd Month of the 3rd Month of the
Withholding Tax Total Quarter
Quarter Quarter Quarter
Payments for medical/dental/veterinary services WI150 7,000.00 - - 7,000.00 700.00
- -

Total 700.00
Money Payments Subject to Withholding
of Business Tax (Government & Private)

Total

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 provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, we give our consent to
the processing of our information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

ENRICO P. EVANGELISTA, MD, DPBA, MHA

FINANCE OFFICER / 206-449-940-0000
Signature over Printed Name of Payor/Payor’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
CONFORME:

REYES, ANELYN
9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3
Signature over Printed Name of Payee/Payee’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)
 Republic of the Philippines
For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Creditable Tax
2307
January 2018 (ENCS)
Withheld at Source 2307 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".

1 For the Period From 1 2 01 2 0 2 0 (MM/DD/YYYY) To 1 2 3 1 20 20 (MM/DD/YYYY)

Part I – Payee Information

2 Taxpayer Identification Number (TIN) 9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3

3 Payee’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

REYES, ANELYN
4 Registered Address 4A ZIP Code

4114
5 Foreign Address, if applicable

Part II – Payor Information

6 Taxpayer Identification Number (TIN) 008 - 323 - 736 - 00000

7 Payor’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

DASMARINAS CITY MEDICAL CENTER INC.

8 Registered Address 8A ZIP Code

DCMCI BLDG. SALAWAG CROSSING CITY OF DASMARINAS CAVITE 4114

Part III – Details of Monthly Income Payments and Taxes Withheld
AMOUNT OF INCOME PAYMENTS
Income Payments Subject to Expanded Tax Withheld for the
ATC 1st Month of the 2nd Month of the 3rd Month of the
Withholding Tax Total Quarter
Quarter Quarter Quarter
Payments for medical/dental/veterinary services WI150 - - 3,000.00 3,000.00 300.00
- -

Total 300.00
Money Payments Subject to Withholding
of Business Tax (Government & Private)

Total

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 provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, we give our consent to
the processing of our information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

ENRICO P. EVANGELISTA, MD, DPBA, MHA

FINANCE OFFICER / 206-449-940-0000
Signature over Printed Name of Payor/Payor’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
CONFORME:

REYES, ANELYN
9 0 7 - 3 1 1 - 5 4 2 - 0 0 0 0 3
Signature over Printed Name of Payee/Payee’s Authorized Representative/Tax Agent
(Indicate Title/Designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY)
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)
 4/2/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00
4/8/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00
2,000.00
2,000.00

Prepared By: Received By:

Jacqueline J. Pamalin

5/15/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00

1,000.00
1,000.00

Prepared By: Received By:

Jacqueline J. Pamalin

9/9/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,111.11

9/24/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 375.00
1,486.11
1,486.11

6/29/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 30,000.00

30,000.00
30,000.00

Prepared By: Received By:

Jacqueline J. Pamalin

10/2/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00

10/15/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00
10/18/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00
10/18/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00
10/12/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 3,000.00
7,000.00
7,000.00

Prepared By: Received By:

 Jacqueline J. Pamalin

12/11/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00

12/16/2020 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00
27-Nov-20 DR-000056 REYES, ANELYN LOGRONO 907-311-542-0003 1,000.00
3,000.00
3,000.00

Prepared By: Received By:

Jacqueline J. Pamalin
 100.00 900.00 0.1 Garcia, Sean 152990
100.00 900.00 0.1 Galindo, Kalea Summer 153243
200.00 1,800.00 -
WI150

100.00 900.00 0.1 Salimbot, Jeremy 155189

100.00 900.00 -
WI150

111.11 1,000.00 0.1 Celis, Joakim 163842

37.50 337.50 0.1 Davis, Rain 164395
148.61 1,337.50
WI150

3,000.00 27,000.00 0.1 CHECKED RELEASED HONORARIUM - MARCH - MAY 2020

3,000.00 27,000.00 -
WI011

100.00 900.00 0.1 Clarito, Erkin 166658

100.00 900.00 0.1 Tan, Janelle 167586
100.00 900.00 0.1 Tan, Janelle Allyza 167772
100.00 900.00 0.1 Paredes, Dion Franco 167782
300.00 2,700.00 0.1 CHECKED RELEASED PF-PHIC - SEPT 2017 - DEC., 2017
700.00 6,300.00 -
WI150
 100.00 900.00 0.1 Pungyan, Justin 172598
100.00 900.00 0.1 Sabusap, Gavin Miguel 173177
100.00 900.00 0.1 CHECKED RELEASED PF-PHIC - DECEMBER, 2018
300.00 2,700.00
WI150