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Annex C RR 11 2018 PDF
Annex C RR 11 2018 PDF
1. That there are ____________ income payees (self-employed individuals) where no withholding is made, consisting of
the following:
2. That the above payees where no withholding tax is deducted from their income payment/s have executed the required
Income Payee’s Sworn Declarations on the amount of gross receipts which they expect to receive for the year
______________, and these sworn declarations are duly received together with copies of their Certificate of
Registration (COR);
3. That there are _________ individual income payees withheld five percent (5%) withholding tax rate due to their
submission of “Payee’s Sworn Declaration of Gross Receipts/Sales” stating that their gross receipts/sales shall not
exceed ₱3,000,000 (₱3M) for the current year, while ______ non-individual payees submitted “Income Payee’s Sworn
Declaration” stating that their gross receipts/sales shall not exceed P720,000 for the current year;
4. That I am attaching with this sworn declaration the list of individual payees subject of items 1 and 2 above consisting
of ________ number of pagers, the list of individual payees subject of item 3 above with ____________ number of
pages, and the list of non-individual payees subject also of item 3 above with _________ number of pages;
5. That the submission is in compliance with the requirements prescribed under Section _________ of Revenue
Regulations No. ___________.
6. That this declaration, including the attached list/s, is made in good faith, to the best of my knowledge and belief, to be
true and correct, under the penalties of perjury.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________, 20___ at ___________, Philippines
__________________________________________________
Signature over Printed Name of Withholding Agent/Authorized Officer of the Withholding
Agent
__________________________________________________
Designation/Position if Authorized Officer
__________________________________________________
Name of Withholding Agent/Lone Payor
NOTARY PUBLIC
Doc. No.: __________
Page No.: __________
Book No.: __________
Series of ___________
Affix ₱30.00
Documentary
Stamp Tax
__________________________________________________________
Designation/Position of Revenue Officer
__________________________________________________________
RDO No.