BIR FORM

1921
REVISED: APRIL 2019
REPUBLIKA NG PILIPINAS
KAGAWARAN NG PANANALAPI
KAWANIHAN NG RENTAS INTERNAS
REVENUE REGION NO. 001 – CALASIAO
REVENUE DISTRICT OFFICE NO. 003 – SAN FERNANDO, LA UNION

OCN: 003AU20220000007407
Date of ATP: December 6, 2022

AUTHORITY TO PRINT
TAXPAYER DETAILS
TIN & BRANCH CODE NAME
603-498-179-00000 DELA CRUZ, JOMAR CORPUZ
BUSINESS/TRADE NAME
SUMANULTOP BEVERAGE SHOP
REGISTERED
BACCUIT SUR 2501 BAUANG LA UNION PHILIPPINES
PRINTER DETAILS
TIN AND BRANCH CODE NAME
164-413-070-00000 ERNESTO SR. IBASAN UBANDO
REGISTERED ADDRESS
SAN AGUSTIN EAST 2504 AGOO LA UNION PHILIPPINES
ACCREDITATION NO ACCREDITATION ISSUE DATE (MM/DD/YYYY)
003MP20180000000005 12/17/2018
DESCRIPTION OF RECEIPT/INVOICES
B. PRINCIPAL RECEIPTS/INVOICES
NO. OF NO. OF SETS NO. OF COPIES SERIAL NUMBERS
DESCRIPTION TYPE MANNER BOXES/BOOK PER PER SET
LETS BOX/BOOKLET FROM TO

SALES INVOICE NON-VAT BOUND 50 50 2 0001 2500

REMINDER:
BIR accredited printer shall have the printer’s certificate of delivery (PCD) of receipts/invoices stamped “Registered “by the
concerned RDO/LT office of the taxpayer before delivery of the printed receipts/invoice to the taxpayer - user. The certified
photocopy of the ATP and the Taxpayer – user’s sworn statement shall likewise be Filed/Distributed together with the PCD
to the concerned RDO/LT office within Thirty (30) days from date of PCD.

NICANOR S. VENTURA
REVENUE DISTRICT OFFICER
(Signature over Printed Name)

REPUBLIKA NG PILIPINAS

PAGE 1 of 1
 BIR FORM
1921
REVISED: APRIL 2019
KAGAWARAN NG PANANALAPI
KAWANIHAN NG RENTAS INTERNAS
REVENUE REGION NO. 001 – CALASIAO
REVENUE DISTRICT OFFICE NO. 003 – SAN FERNANDO, LA UNION

OCN: 003AU20220000007406
Date of ATP: December 6, 2022

AUTHORITY TO PRINT
TAXPAYER DETAILS
TIN & BRANCH CODE NAME
403-375-788-00000 PAREDES, JUVY PANICO
BUSINESS/TRADE NAME
MARWAJOSH GENERAL MERCHANDISE
REGISTERED ADDRESS
SUYO (POB.) 2512 BAGULIN LA UNION PHILIPPINES
PRINTER DETAILS
TIN AND BRANCH CODE NAME
164-413-070-00000 ERNESTO SR. IBASAN UBANDO
REGISTERED ADDRESS
SAN AGUSTIN EAST 2504 AGOO LA UNION PHILIPPINES
ACCREDITATION NO ACCREDITATION ISSUE DATE (MM/DD/YYYY)
003MP20180000000005 12/17/2018
DESCRIPTION OF RECEIPT/INVOICES
A. PRINCIPAL RECEIPTS/INVOICES
NO. OF NO. OF NO. OF COPIES SERIAL NUMBERS
DESCRIPTION TYPE MANNER BOXES/BOO SETS PER PER SET
KLETS BOX/BOOKL FROM TO
ET
SALES
INVOICE NON-VAT BOUND 50 50 2 2501 5000
REMINDER:
BIR accredited printer shall have the printer’s certificate of delivery (PCD) of receipts/invoices stamped
“Registered “by the concerned RDO/LT office of the taxpayer before delivery of the printed receipts/invoice
to the taxpayer - user. The certified photocopy of the ATP and the Taxpayer – user’s sworn statement shall
likewise be Filed/Distributed together with the PCD to the concerned RDO/LT office within Thirty (30) days
from date of PCD.

NICANOR S. VENTURA
REVENUE DISTRICT OFFICE
(Signature over Printed Name)

REPUBLIKA NG PILIPINAS

PAGE 1 of 1
 BIR FORM
1921
REVISED: APRIL 2019
KAGAWARAN NG PANANALAPI
KAWANIHAN NG RENTAS INTERNAS
REVENUE REGION NO. 001 – CALASIAO
REVENUE DISTRICT OFFICE NO. 003 – SAN FERNANDO, LA UNION

OCN: 003AU20220000007409
Date of ATP: December 6, 2022

AUTHORITY TO PRINT

TAXPAYER DETAILS
TIN & BRANCH CODE NAME
278-944-260-00000 IBALE, ARLENE BARACENA
BUSINESS/TRADE NAME
ARLENE’S GENERAL MERCHANDISE
REGISTERED ADDRESS
122 BUSSAOIT 2515 BACNOTAN LA UNION PHILIPPINES
PRINTER DETAILS
TIN AND BRANCH CODE NAME
164-413-070-00000 ERNESTO SR. IBASAN UBANDO
REGISTERED ADDRESS
SAN AGUSTIN EAST 2504 AGOO LA UNION PHILIPPINES
ACCREDITATION NO ACCREDITATION ISSUE DATE (MM/DD/YYYY)
003MP20180000000005 12/17/2018
DESCRIPTION OF RECEIPT/INVOICES
A. PRINCIPAL RECEIPTS/INVOICES
NO. OF NO. OF SETS NO. OF SERIAL NUMBERS
DESCRIPTION TYPE MANNER BOXES/BOOK PER COPIES PER
FROM TO
LETS BOX/BOOKLET SET

SALES INVOICE NON-VAT BOUND 50 50 2 4501 7000

NICANOR S. VENTURA
REVENUE DISTRICT OFFICER
(Signature over Printed Name)

PAGE 1 of 1
 BIR FORM
1921
REVISED: APRIL 2019
REPUBLIKA NG PILIPINAS
KAGAWARAN NG PANANALAPI
KAWANIHAN NG RENTAS INTERNAS
REVENUE REGION NO. 001 – CALASIAO
REVENUE DISTRICT OFFICE NO. 003 – SAN FERNANDO, LA UNION

OCN: 003AU20220000007407
Date of ATP: December 6, 2022

AUTHORITY TO PRINT
TAXPAYER DETAILS
TIN & BRANCH CODE NAME
318-137-353-00000 ALAVAREN, MARLON ESTRELLA
BUSINESS/TRADE NAME
MARIFLOR GENERAL MERCHANDISE
REGISTERED ADDRESS
CSI THE CITY MALL DIVERSION ROAD BIDAY 2500 CITY OF SAN FERNANDO LA UNION PHILIPPINES
PRINTER DETAILS
TIN AND BRANCH CODE NAME
164-413-070-00000 ERNESTO SR. IBASAN UBANDO
REGISTERED ADDRESS
SAN AGUSTIN EAST 2504 AGOO LA UNION PHILIPPINES
ACCREDITATION NO ACCREDITATION ISSUE DATE (MM/DD/YYYY)
003MP20180000000005 12/17/2018
DESCRIPTION OF RECEIPT/INVOICES
A. PRINCIPAL RECEIPTS/INVOICES
DESCRIPTION TYPE MANNER NO. OF NO. OF SETS NO. OF COPIES SERIAL NUMBERS
BOXES/BOO PER PER SET FROM TO
KLETS BOX/BOOKLET
SALES INVOICE NON-VAT BOUND 50 50 2 15501 18000
REMINDER:
BIR accredited printer shall have the printer’s certificate of delivery (PCD) of receipts/invoices stamped
“Registered “by the concerned RDO/LT office of the taxpayer before delivery of the printed receipts/invoice
to the taxpayer - user. The certified photocopy of the ATP and the Taxpayer – user’s sworn statement shall
likewise be Filed/Distributed together with the PCD to the concerned RDO/LT office within Thirty (30) days
from date of PCD.

NICANOR S. VENTURA
REVENUE DISTRICT OFFICE
(Signature over Printed Name)

PAGE 1 of 1
BIR FORM
1921
REVISED: APRIL 2019

PAGE 1 of 1