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Annex C.1

1. Eric Velez Olay is applying for a Tax Clearance on behalf of Passion Healthcare Phils, Inc. for bidding purposes. 2. Passion Healthcare Phils, Inc. is a corporation registered with the BIR with TIN 008-085-630-000. 3. Eric Olay is authorized to complete the sworn application and has attached the required documents including a tax compliance verification sheet, documentary stamp taxes, and proof of payment for certification fee.

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895 views1 page

Annex C.1

1. Eric Velez Olay is applying for a Tax Clearance on behalf of Passion Healthcare Phils, Inc. for bidding purposes. 2. Passion Healthcare Phils, Inc. is a corporation registered with the BIR with TIN 008-085-630-000. 3. Eric Olay is authorized to complete the sworn application and has attached the required documents including a tax compliance verification sheet, documentary stamp taxes, and proof of payment for certification fee.

Uploaded by

Eric Olay
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines April 2018 Version

Department of Finance
BUREAU OF INTERNAL REVENUE
Quezon City Annex C.1
April 2018 VERSION

SWORN APPLICATION FOR TAX CLEARANCE


(To be accomplished by the Authorized Officer of Non-Individual Taxpayer
Securing Tax Clearance for Bidding Purposes)

I, Eric Velez Olay with Taxpayer Identification Number (T.I.N.) 926-894-224-000, Filipino, of legal
age, married/single, permanently residing at UG-10 Tower B Palm Towers # 7706 St Paul Road San Antonio
City Makati with Contact No. (0995) 922-1473, and Email Address eric.olay@northmedtechnology.com,
after having been duly sworn to in accordance with law hereby depose and state:

1. That, Passion Healthcare Phils, Inc (name of the non-individual taxpayer-applicant) with Taxpayer
Identification Number (TIN) 008-085-630-000 is a corporation/company duly recognized and existing
under and by virtue of the Laws of the Philippines, with Office located at 1707 Dapitan St. Brgy. 488
Zone 048 Sampaloc Manila 1008;

2. That, it is registered with BIR under Certificate of Registration No. 1RC0000592073 issued at Revenue
District Office/LTDO No. 032 on November 19, 2012;

3. That, the undersigned is the Authorized Officer of the aforesaid corporation/company to accomplish this
sworn application for the issuance of Tax Clearance (for Bidding Purposes), a pre-requisite for entering
into any contract with the Government Agency as prescribed under EXECUTIVE ORDER NO. 398,
as implemented by RR No. 3-2005, as amended;

4. That, the following documents attached to this Sworn Application are all authentic and hereto attached
in compliance with the existing policies:

_____ a. Tax Compliance Verification Sheet issued by ______________________on ________; (and for
Branch Office, if applicable)
_____ b. Two (2) pieces of loose documentary stamp tax worth P30.00 each;
_____ c. Confirmation Receipt of Electronic payment of certification fee worth Php 100.00 or other proof of
payment;
_____ d. Valid and properly accomplished authorization letter with photocopies of any government issued I.D.
showing the picture and signature of the applicant and the authorized representative; and
_____ e. Original unexpired Tax Clearance Certificate for Bidding Purposes (if applicable).

5. And that, to the best of my knowledge and belief, the aforesaid company has satisfied with the
prescribed criteria for the issuance of Tax Clearance.

____________________________________________
Signature over Printed Name of Authorized Officer

SUBSCRIBED AND SWORN to before me this _____ day of _________________________,


20___ in _______________________________. Applicant exhibited to me his/her valid and current
Government Issued Identification Card ___________________________with ID No. _________________.

Doc. No. __________


Page No. __________
BookNo._________
Series of __________ _____________________________________
Notary Public
-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.
! Affix !
! P30.00 !
! Documentary Stamp Tax !
!-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-!

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