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Republic of the Philippines
Department of Finance BUREAU OF INTERNAL REVENUE Quezon City
SWORN APPLICATION FOR TAX CLEARANCE (To be accomplished by Individual Taxpayer Securing Tax Clearance for Bidding)
I, _________________________________________________, Filipino/_____________(indicate nationality for non-Filipino citizenship), of legal age, single/married to_____________________________________, permanently residing at _____________________________________________________________ with Taxpayer Identification Number (TIN) __________________________________, after having been duly sworn in accordance with law hereby depose and state:
1. That I am the Owner/Proprietor/Proprietress of ____________________________________________________________ with business address at _____________________________________________________________________________, with Telephone/Cellular Phone No. ______________________and email address _______________________________; 2. That my business trade name has been duly registered with the Department of Trade and Industry on ______________________________ under DTI Registration Certificate No. _________________________________; 3. That I registered my business with BIR under Certificate of Registration No.______________________issued at Revenue District Office No. _____________ on ___________________________________________________; 4. That, I am securing/applying for TAX CLEARANCE, a pre-requisite for entering into any contract with the Government Agencies as required under Executive Order No. 398, and implemented by RR No. 3-2005, as amended; 5.
That, the following documents required in relation to the aforesaid application are all authentic and hereto attached in compliance with the existing policy. a. Delinquency Verification Certificate issued by __________________________on ________; b.Two (2) pieces of loose documentary stamp tax worth P15.oo each; and c. Confirmation Receipt of Electronic payment of certification fee.
6. And that, to the best of my knowledge, I have satisfied with the prescribed criteria for the issuance of Tax Clearance.
_____________________________________________ Signature over Printed Name of Applicant
SUBSCRIBED AND SWORN to before me this __________ day of ____________________________, ___ in _______________________________. Applicant exhibited to me his/her Community Tax Certificate No. _________________issued at __________________________ on ___________________________.
Doc. No. __________ Page No. __________ Book No. _________ Series of __________ -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-. ! Affix ! ! P15.00 ! ! Documentary Stamp Tax ! !-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-!
________________________________________ Notary Public