(To be filled out by BIR) DLN: _________________

BIR Form No.

Republic of the Philippines
Application for Registration
Department of Finance
Bureau of Internal Revenue 1902
January 2018 (ENCS)
For Individuals Earning Purely Compensation Income
(Local and Alien Employee)
- - - 0 0 0 0 0
New TIN to be issued, if applicable (To be filled out by BIR)
Fill in all applicable white spaces. Write “NA” for those not applicable. Mark all appropriate boxes with an “X”
Part I - Taxpayer/Employee Information
1 PhilSys Number (PSN) 2 Taxpayer Type 3 BIR Registration Date
(To be filled out by BIR) (MM/DD/YYYY)
X Local Resident Alien Special Non-Resident Alien
4 Taxpayer Identification Number (TIN) 5 RDO Code
(For Taxpayer with existing TIN) 232 - 4 4 4 - 5 2 2 - 0 0 0 0 0 (To be filled out by BIR)

6 Taxpayer’s Name
Last Name First Name
BELDUA RICHARD
Middle Name Suffix 7 Gender
LIBUNAO X Male Female

8 Civil Status Single X Married Widow/er Legally Separated

9 Date of Birth (MM/DD/YYYY) 10 Place of Birth
03 11 1 9 7 3 NAGA CITY
11 Mother’s Maiden Name (First Name, Middle Name, Last Name)
ESPERANZA PALANCA LIBUNAO
12 Father’s Name (First Name, Middle Name, Last Name)
RICARDO ESTRADA BELDUA
13 Citizenship 14 Other Citizenship
FILIPINO
15 Local Residence Address
Unit/Room/Floor/Building No. Building Name/Tower
25
Lot/Block/Phase/House No. Street Name
DE OCAMPO
Subdivision/Village/Zone Barangay
DBP VILLAGE ALMANZA DOS
Town/District Municipality/City
LAS PIÑAS
Province ZIP Code
1751
16 Foreign Address

17 Municipality Code
(To be filled out by BIR) 18 Tax Type ,INCOME1TAX, 19 Form Type ,BIR Form1No. 1700 , 20 ATC II,011.
21 Identification Details (e.g. passport, government issued ID, company ID, etc.)
Type Number Effective Date (MM/DD/YYYY) Expiry Date (MM/DD/YYYY)

LTO LICENSE N03-92-121787 0 2 0 9 2 0 1 8 03 1 1 2022

Issuer Place/Country of Issue LAS PINAS CITY
22 Preferred Contact Type Landline No. X Mobile Number 09338153442
X Email Address (required)
[email protected]
Part II - Spouse Information (if applicable)
23 Employment Status of Spouse
X Unemployed Employed Locally Employed Abroad Engaged in Business/Practice of Profession
24 Spouse Name
Last Name First Name

BELDUA CLARIZZA
Middle Name Suffix 25 Spouse TIN
DOMINGO Mrs. - - - 0 0 0 0 0
26 Spouse Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)

27 Spouse Employer’s TIN - - -

 BIR Form No. 1902-page 2
Part III - For Employee with Two or More Employers (Multiple Employments) Within the Calendar Year
28 Type of Multiple Employments
Successive Employments (With previous employer/s within the calendar year)
Concurrent Employments (With two or more employers at the same time within the calendar year)
(If successive, enter previous employer/s; if concurrent, enter secondary employer/s )
Previous and/or Concurrent Employments During the Calendar Year
29A Name of Employer

29B TIN of Employer

30A Name of Employer

30B TIN of Employer

31A Name of Employer

31B TIN of Employer

32 Declaration
I declare under the penalties of perjury that this application, and all its attachments, have been made in good faith, verified by me and to the best of my
knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority
thereof. Further, I give my consent to the processing of my information as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful
purposes.

________________________________________
Taxpayer(Employee)/Authorized Representative
(Signature over Printed Name)
Part IV – Primary/Current Employer Information
33 Type of Registering Office 34 TIN 009 - 497 - 095 - 0 0 0 0 35 RDO Code 52
Head Office Branch Office
36 Employer’s Name (Last Name, First Name, Middle Name, If Individual) (Registered Name, If Non Individual)

NOT JUST LIGHTING INC.

37 Employer’s Address
Unit/Room/Floor/Building No. Building Name/Tower
360
Lot/Block/Phase/House No. Street Name
AGUIRRE AVE.
Subdivision/Village/Zone Barangay
BF HOMES BF HOMES
Town/District Municipality/City

PARAÑAQUE
Province ZIP Code

1720
38 Contact Details
Landline Number Fax Number Mobile Number

39 Relationship Start Date/Date Employee was Hired 40 Municipality Code (To be filled out by BIR)
(MM/DD/YYYY)
41 Declaration Stamp of BIR Receiving Office
I declare under the penalties of perjury that this application and all its attachments, have been made in good faith, verified by me and Date of Receipt
and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as
amended, and the regulations issued under authority thereof. Further, I give my consent to the processing of my information as
contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

LUTESS MARJORIE MACALISANG

_______________________________________ __________________________
EMPLOYER/AUTHORIZED REPRESENTATIVE Title/Position of Signatory
(Signature over Printed Name)
*Note: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)

Documentary Requirements:

For Local Employee: For Alien Employee:

1. Any identification issued by an authorized government body (e.g. Birth 1. Passport
Certificate, Passport, Driver’s License, etc.) that shows the name, 2. Working Permit or photocopy of duly received Application for Alien
address and birthdate of the applicant. Employment (AEP) by the Department of Labor and Employment
2. Marriage Contract, if applicable. (DOLE)

POSSESSION OF MORE THAN ONE TAXPAYER IDENTIFICATION NUMBER (TIN) IS CRIMINALLY PUNISHABLE PURSUANT TO THE
PROVISIONS OF THE NATIONAL INTERNAL REVENUE CODE OF 1997, AS AMENDED.