ANNEX “B-3”
INCOME PAYEE’S SWORN DECLARATION OF GROSS RECEIPTS/SALES
(For Non-Individual Taxpayer with Several Income Payors)
I, IDAN H. AGUIRRE , __ Filipino ,
authorized officer of
(Name) (Citizenship)
FIRST PLATINUM SALES REALTY CO., with registered
address at
(Name of Non-Individual Income Payee)) _____Sabang, Lipa City, Batangas
with (Address)
Taxpayer Identification Number (TIN) 008-682-085-000, after having been duly sworn in
accordance with law hereby depose and state:
1. That for the current year 2024, the gross receipts of the aforesaid non-
individual payee will not exceed Seven Hundred Twenty Pesos (₱720,000);
2. That I duly execute this SWORN DECLARATION in compliance with the
requirement prescribed under Section __2__ of Revenue Regulations No. 11-
2018;
3. That I declare, under the penalties of perjury, that this declaration has been
made in good faith, and to the best of my knowledge and belief to be true
and correct.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________,
20___ at ___________, Philippines.
IDAN H. AGUIRRE
__________________________________________
Signature over Printed Name of Individual
Taxpayer
SUBSCRIBED AND SWORN to before me this _____ day of ____________, 20___ in
_______________________________. Applicant exhibited to me his/he Tin Id 419-231-689-
000_issued at Lipa City on May 19, 2013.
(Government Issued ID and No.)
Doc. No.: __________
Page No. __________
Book No.: __________
Series of 2023
Affix ₱30.00
Documentary
Stamp Tax
(To be filled-out by the withholding agent/lone payor)
Date Received: __________________ Received by:
(MM-DD-YYYY-00001)
_____________________________________________________________
Signature over Printed Name of the Withholding Agent/Payor or Authorized Officer
_____________________________________________________________
Designation/Position of Authorized Officer
_____________________________________________________________
Name of Withholding Agent/Lone Payor
