(To be filled up by the BIR)

- DLN: - PSOC: - PSIC:

Republika ng Pilipinas
Quarterly Remittance Return
Kagawaran ng Pananalapi BIR Form No.
Kawanihan ng Rentas Internas of Final Income Taxes Withheld
1603
On Fringe Benefits Paid to Employees Other than Rank and File November 2004 (ENCS)
Fill in all applicable spaces. Mark all appropriate boxes with an "X"
1 For the Year 2 Quarter 3 Months Reflected in this Return 4 Amended 5 Any Taxes
(YYYY) Return ? Withheld?
January February March
2012 ý ¨ ¨ ¨ ¨ Yes ý No ý Yes ¨ No
1st 2nd 3rd 4th
Part I Background Information
6 TIN TAX12345 7 RDO Code 8 Line of Business / Manufacturing
Occupation
9 Withholding Agent's Name(Last name,First Name,Middle Name for Individuals)/Registered Name of Non-individuals 10 Telephone
ABC Corporation Ltd., Philippines 123131
11 Registered Address Address1 Address2 12 Zip Code
600001

13 Category of Withholding Agent 14 Are there payees availing of tax relief under Special Law or International Tax Treaty?

ý Private ¨ Government ¨ Yes ý No If yes, specify

Part II - COMPUTATION OF TAX

Tax Base
Recipients ATC Monetary Value Of Percen- Tax Tax Required
Grossed -up
Fringe Benefit tage Rate To Be Withheld
Monetary value
Divisor
15 Alien & Filipino
employed & occupying
the same position as
those of aliens employed
in selected multinational

16 Non-resident Alien not

engaged in Trade or Business
17 Others(In General) 53200.00 68% 78235.29 32% 25035.29
18 Total 18A 53200.00 18B 25035.29
19 Less Taxes Remitted in Return previously filled,if this is an amended Return 19
20 Tax Still Due (Overremittance) 20

21 Add: Penalties
Surcharge Interest Compromise
21A 21B 21C 21D

22 Total Amount Srill Due(Over remittance) 22

If over remittance, mark one box only. To be Refunded To be issued a Tax Credit Certificate
We declare, under the penalties of perjury,that this return has been made in good faith,verfied by me/us, and to the best of my/our knowledge is true
and correct, pursuant to the provisions of the National Internal Revenue Code,as amended,and the regulations issued under authority .
23 S. Scott 24
Treasurer/Asst. Treasurer
President/Vice President/Principal Officer/Accredited Tax
(Signature Over Printed Name)
Agent/Authorized Representative/Taxpayer
(Signature Over Printed Name)

Title/Position of Signatory Title/Position of Signatory

Part III Details of Payme

Stamp
Particulars Drawee bank/Agency Number Date Amount of
DD MM YY
receiving
25 Cash/Bank 25A 25B 25C 25C Office and
Debit Memo
26 Check 26A 26C 25A 25C
27 Others 27A
27C 25A 25C
Machine Validation/Revenue Official Receipt Details( If not filled with the Bank )
*Note: For Taxe rates and percentage of divisors, please see instruction in the back
1 For the Year 2 Quarter 3 Months Reflected in this Return 4 Amended 5 Any Taxes
(YYYY) Return ? Withheld?
January February March
2012 ý ¨ ¨ ¨ ¨ Yes ý No ý Yes ¨ No
1st 2nd 3rd 4th
Part I Background Information
6 TIN TAX12345 7 RDO Code 8 Line of Business / Manufacturing
Occupation
9 Withholding Agent's Name(Last name,First Name,Middle Name for Individuals)/Registered Name of Non-individuals 10 Telephone
ABC Corporation Ltd., Philippines 123131
11 Registered Address Address1 Address2 12 Zip Code
600001

13 Category of Withholding Agent 14 Are there payees availing of tax relief under Special Law or International Tax Treaty?

ý Private ¨ Government ¨ Yes ý No If yes, specify

Part II - COMPUTATION OF TAX

Tax Base
Recipients ATC Monetary Value Of Percen- Tax Tax Required
Grossed -up
Fringe Benefit tage Rate To Be Withheld
Monetary value
Divisor
TIN of Accredited tax Agent (if TIN of Accredition No. (if applicable)
applicable)

Part III Details of Payme

Stamp
Particulars Drawee bank/Agency Number Date Amount of
DD MM YY
receiving
25 Cash/Bank 25A 25B 25C 25C Office and
Debit Memo
26 Check 26A 26C 25A 25C
27 Others 27A
27C 25A 25C
Machine Validation/Revenue Official Receipt Details( If not filled with the Bank )
*Note: For Taxe rates and percentage of divisors, please see instruction in the back