0901-D Tax Treaty Relief Application for Dividend Income

BIR application form for tax treaty relief dividend income

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PSIC:

BIR Form No.
Republika ng Pilipina s
Kagawar an ng Pananalapi

1702AIF

Account Information Form

Kawanihan ng Rentas Internas

July 1999 (ENCS)
Revised: May 1996

(To be accomplished & filed
with BIR Form No. 1702)

For Corporations and Partnerships in General
1

For the

Calendar

2

Fiscal

Year Ended
(MM/YYYY)

,
Background

Part I
3
4

Taxpayer
Identification No.
Taxpayer

Information

3
5

BIR Registration
Date

7

BIR Ruling, if applicable
Date of Approval

Registered Name
6

Type of Exemption (Mark one box only, if applicable)
Private Foundation

8

Retirement Plan

Cooperative

Others (Specify)

Accounting Method Used: (Mark one box only)
Cash

Accrual

9

Others (Specify)

Method of Inventory Valuation

(MM/ DD/ YYYY)

10

(Specify)

(MM/ DD/ YYYY)

Number

Method of Bookkeeping
Manual

Computerized

If computerized, Permit No.
Mixed

Income Statement

Part II

E X E M P T
Previous Year

T A X A B L E

SPECIAL RATE
Current Year

Previous Year

Current Year

REGULAR RATE
Previous Year

Current Year

11 Gross Sales/ Revenues/
Receipts/ Fees
12 Less: Sales Returns and
Allowances
13
Sales Discounts

11A

11B

11C

11D

11E

11F

12A

12B

12C

12D

12E

12F

13A

13B

13C

13D

13E

13F

14 Net Sales/ Revenues/
Receipts/Fees

14A

14B

14C

14D

14E

14F

15A

15B

15C

15D

15E

15F

16B

16C

16D

16E

16F

17B

17C

17D

17E

17F

18B

18C

18D

18E

18F

19B

19C

19D

19E

19F

20A

20B

20C

20D

20E

20F

21A

21B

21C

21D

21E

21F

22B

22C

22D

22E

22F

23B

23C

23D

23E

23F

24B

24C

24D

24E

24F

(Item 11 less Items 12 & 13)

15 Less: Cost of Sales/ Services/
16A
Direct Costs
16 Gross Profit From Operations
Add: Non-operating Income
17 Gain from Sales/Exchanges 17A
of Real Property (Sch.1)
18 Gain from Sales/Exchanges 18A
of Other Fixed Assets,Scrap, etc.
19 Gain from Sales/Exchanges 19A

of Stocks
20 Other Income (Sch.8)
21 Total Gross Income
(Sum of Items 16,17,18,19 & 20)

Less: Expenses (Not Included in Costs of Sales/Services)
22 Fund Utilization (For Ex- 22A
empt Activity of Exempt
Corporation) (Sch. 4)
23A
23 Salaries and Allowances
24A

24

Fringe Benefits

1702AIF (ENCS) - PAGE 2

E X E M P T
Previous Year

T A X A B L E

SPECIAL RATE
Current Year

Previous Year

Current Year

REGULAR RATE
Previous Year

Current Year

25B

25C

25D

25E

25F

26B

26C

26D

26E

26F

27A

27B

27C

27D

27E

27F

28A

28B

28C

28D

28E

28F

29A

29B

29C

29D

29E

29F

30A

30B

30C

30D

30E

30F

31A

31B

31C

31D

31E

31F

32A

32B

32C

32D

32E

32F

Repairs and Maintenance
33A
Representation and

33B

33C

33D

33E

33F

34A

34B

34C

34D

34E

34F

35A

35B

35C

35D

35E

35F

36A

36B

36C

36D

36E

36F

37A

37B

37C

37D

37E

37F

38A

38B

38C

38D

38E

38F

39A

39B

39C

39D

39E

39F

40A

40B

40C

40D

40E

40F

41A

41B

41C

41D

41E

41F

42A

42B

42C

42D

42E

42F

43A

43B

43C

43D

43E

43F

44A

44B

44C

44D

44E

44F

45A

45B

45C

45D

45E

45F

46A

46B

46C

46D

46E

46F

Research and Development
Amortization of Pension 47A

47B

47C

47D

47E

47F

48A

48B

48C

48D

48E

48F

49A

49B

49C

49D

49E

49F

50A

50B

50C

50D

50E

50F

25A
HDMF and Other Contributions
26A

25

SSS, GSIS, Medicare,

26

Commission

27

Outside Services

28

Advertising

29

Rental

30

Insurance

31

Royalties

32
33

Entertainment

34

Transportation and Travel

35
36

Fuel and Oil
Communications, Light
and Water

37

Supplies

38

Interest

39

Taxes and Licenses (Sch.6)

40

Losses

41

Bad Debts

42

Depreciation

43

Amortization of Intangibles

44

Depletion

45

Charitable Contribution

46
47

Trust Contribution

48
49

Miscellaneous
Total Expenses
(Sum of Items 22 to 48)

50

Net Income / (Loss)
(Item 21 less Item 49)

1702AIF (ENCS) - PAGE 3

Part III
ASSETS
Current Assets
51 Cash on Hand and in Banks

51A

51B

52

52A

52B

Marketable Securities

Balance Sheet
Beginning

Ending

Beginning
75

Fixed Asset - Appraisal Increase

Ending

75A

75B

76 Less: Accumulated Depreciation, 76A

76B

Appraisal Increase

53

Accounts Receivable - Trade

53A

53B

77

Net Book Value-Fixed Asset-

77A

77B

Appraisal Increase (Item 75 less Item 76)

54 Less: Allowance for Bad Debts 54A
55
56

Net Accounts Receivable - Trade
(Item 53 less Item 54)
Other Receivables

54B

55A

78A

78B

79A

79B

56B

Inventory
57 Finished Goods/ Merchandise 57A

Other Assets
80A
80 Other Assets
81 Total Assets
81A
(Sum of Items 63, 67, 78, 79 & 80)
LIABILITIES AND STOCKHOLDERS' / PARTNERS' EQUITY
Current Liabilities
82 Accounts Payable - Trade
82A

57B

58 Goods in Process

58A

58B

59 Raw Materials

59A

59B

60 Supplies
61

Total Fixed Tangible Assets
(Sum of Items 68, 71, 74 & 77)
Intangible Assets
79 Intangibles

55B

56A

78

60A

60B

Total Inventory

61A

61B

83 Other Payables

80B
81B

82B

62A

Total Current Assets

63A

84B

85A

85B
86B

87A

87B

88A

88B

89A
89 Premium (Discount) on Capital
Stock
90A
90 Retained Earnings/(Deficit)
(Schedule 9)
91A
91 Appraisal Capital
92A
92 Donated Capital
93A
93 Treasury Stock
94 Total Stockholder's Equity
94A

89B

Total Current Liabilities
(Sum of Items 82 & 83)
Long-Term Liabilities
85 Long-Term Debts

62B

63

84A

86A

Prepayments

83B

84

(Sum of Items 57 to 60)

62

83A

63B
Deferred Credits / Other Liabilities

(Sum of Items 51, 52, 55, 56, 61 & 62)

Long-Term Investments
64 Stocks & Bonds

64A

64B

65 Real Estate

65A

65B

66 Others

66A

66B

Total Long-Term Investments
(Sum of Items 64 to 66)
Fixed Tangible Assets
68 Land

67A

67B

68A

68B

69

69A

69B

70 Less: Accumulated Depreciation 70A

70B

67

71
72

Building

Net Book Value - Building
(Item 69 less Item 70)
Other Depreciable Assets

71A

Deferred Credits/Other Liabilities
Total Liabilities
(Sum of Items 84 to 86)
Stockholders' Equity / Partner's Equity
Stockholder's Equity
88 Capital Stock

71B

72A

86
87

72B

92B
93B
94B

95A

95B

Equity or Fund Balance, End

73B

Net Book Value-Other Depreciable 74A
Assets (Item 72 less Item 73)

91B

(Sum of Items 88 to 92 less Item 93)

95 Partners' Equity (Sch.11)/
73 Less: Accumulated Depreciation 73A

90B

74B

(For Exempt Corp.) (Schedule 10)

74

Total Liabilities and
96A
Stockholders' / Partners' Equity
(Sum of Items 87, 94 & 95)
Gain/ Loss From Sales / Exchanges of Real Properties - (Attach Additional Sheets, if Necessary)
Selling Price/Fair Market Value
Costs & Expenses/Book Value
Gain / (Loss)

Schedule 1
Description of Property

96

96B

Creditable Tax Withheld

Capital Gains Tax Paid

97A

97B

97C

97D

97E

97F

98A

98B

98C

98D

98E

98F

99A

99B

99C

99D

99E

99F

100A

100B

100C

100D

100E

100F

101A

101B

101C

101

Total........................................................…

1702AIF (ENCS) - PAGE 4

Schedule 2
FOR TRADING ACTIVITY:
102 Merchandise Inventory, Beginning 102A

Schedule of Cost of Goods Manufactured and Sold
Regular Rate

Special Rate
102B

Special Rate

Regular Rate

124A
125A

127A

129A

131A

133A

133B
134B
135B
136B

137A

137B

138A

138B

139A

139B

140A

140B

141A

141B
142B

143A

143B

144A

144B

145A

109B

145B

131 Total Manufacturing Overhead

Ending

110 Total Cost of Sales

Others

108B

109A

132B

142A

109 Less: Merchandise Inventory,

132A

136A

108A

131B

135A

130

107B

(Sum of Items 102 & 107)

130B

134A

108 Total Goods Available

Depreciation (Schedule 5)

106B

107A

129B

130A

129

107 Net Purchases

Communications, Light and Water

105B

106A

128B

Repairs and Maintenance

104B

105A

127B

128A

127
128

105 Less: Purchase Returns and
Allowances
106
Purchase Discounts

Taxes and Licenses (Schedule 4)

103B

104A

126B

Research and Development

126

104 Add: Freight - In

Outside Services

125

103A

125B

126A

124
103 Gross Purchases

124B

110A

110B

(Sum of Items 121 to 130)

132 Total Manufacturing Costs

(Item 108 less Item 109)

FOR MANUFACTURING ACTIVITY:
111 Raw Materials Inventory, Beginning 111A

111B

133 Add: Work in Process, Beginning

112 Gross Purchases

112A

112B

134 Less: Work in Process, Ending

113 Add: Freight - In

113A

113B

135 Total Goods Manufactured

114 Less: Purchase Returns and
Allowances

114A

114B

115A

115B

136 Add: Finished Goods Inventory,
Beginning
137 Less: Finished Goods, Ending

115
Purchase Discounts
116 Net Purchases

116A

116B

117 Total Raw Materials Available

117A

117B

118A

118B

119A

119B

138 Total Cost of Goods Manufactured and Sold
FOR SERVICE ACTIVITY:
139 Direct Charges- Salaries, Wages
and Benefits
140 Direct Charges - Materials,
Supplies and Facilities

120A

120B

141 Direct Charges - Depreciation

(Sum of Items 119, 120 and 132)

(Sum of Item 111 & 116)

118 Less: Raw Materials Inventory,
Ending
119 Raw Materials Used
(Item 117 less Item 118)

120 Direct Labor
Manufacturing Overhead:
121 Supervision and Indirect Labor

142 Direct Charges - Rental
121A

121B

143 Direct Charges - Outside Services
122

Supplies and Facilities

122A

122B

144 Direct Charges - Others
123

Rental

123A

123B

145 Total Cost of Services
(Sum of Items 139 to 144)

Schedule 3
Gross Operating Revenues/ Revenues/ Receipts/ Fees From Registered Tax-Exempt Activity
Amount
Nature
146
146 Membership Dues/Assessments

Schedule 4

Fund

Utilization
Amount
153

153 Payment for/Cost of Specified Project
147 Donations, Gifts, Grants

147

154

154 Grants-in-Aid/Donation Distribution/Payment of Benefits
148 Fund Contributions

148

155

155 Distribution to Beneficiaries (Exempt)
149 Proceeds from Sale of Tickets/Performances

149

156

156 Distribution to Beneficiaries (Taxable)
150 Proceeds from Program/Advertising Sponsorships

150

157

157 Others (Specify)
151 Others (Specify)

151

152 Total

152

158 Total

158

1702AIF (ENCS) - PAGE 5

Schedule 5

Schedule of Income - producing Properties
Property

Schedule 6

Nature of Income

Amount of Income

Schedule of Taxes and Licenses
Kind of Tax

Official Receipt No.

Date Paid

Amount

159 A

159B

159C

165A

165B

165C

165D

160 A

160B

160C

166A

166B

166C

166D

161 A

161B

161C

167A

167B

167C

167D

162 A

162B

162C

168A

168B

168C

168D

163 A

163B

163C

169A

169B

169C

169D

164

164 Total

170

170 Total
Payments to Beneficiaries

Schedule 7
Name of Beneficiary

TIN

Amount

Creditable Tax Withheld

Remarks

171A

171B

171C

171D

171E

172A

172B

172C

172D

172E

173A

173B

173C

173D

173E

174A

174B

174C

174D

174E

175A

175B

175C

175D

175E

Schedule 8

Other Income
(Note: If income is tax-exempt, place an "X" under the Exempt column)
Nature of Income

Amount of Income

Creditable Tax Withheld

Final Tax Withheld/Paid

Exempt

176A

176B

176C

176D

177A

177B

177C

177D

178A

178B

177C

178D

179A

179B

179C

179D

179E

180A

180B

180C

180D

180E

181A

181B

181C

181D

181E

182A

182B

182C

182D

182E

183A

183B

183C

183D

183E

184A

184B

184C

184D

176

Interest

177

Rental

178

Dividend
Income from Other Sources:

184 Total

1702AIF (ENCS) - PAGE 6

Schedule 9
185
186
187

Analysis of Changes in Retained Earnings for Corporation
185
Unappropriated Retained Earnings / (Deficit) at the
Beginning of the Taxable Year
186
Add: Net Profit / (Loss) per Books
187A
Other Credits (Specify)

Schedule 10

Schedule of Equity/Fund Balance for Exempt Corporation

194
194 Equity/ Fund Balance, Beginning

187B
195 Excess of Revenues/ Receipts/ Fees over
Expenses or vice versa

188
188
189
190

Total…………………………………………
Less: Dividends Paid during the Year whether in Cash,
Stock or Other Property
Other Debits (Specify)

195

189

196
196 Other Sources of Capital

190A
197
190B

191

197 Add: Appraisal Capital

191
Total Unappropriated Retained Earnings / (Deficit)…………………………………………
Appropriated Retained Earnings:

198
198 Less: Distribution to Members/ Beneficiaries
(Schedule 7)
199

192A

199 Total Equity/ Fund Balance, End
192C

192B
193
Retained Earnings / (Deficit) at the Close of Taxable Year as
shown in the Balance Sheet (From Item 90B of Part III)
Schedule 11

193
Analysis of Changes in Partners' Equity
(Attach additional sheets, if necessary)

Partner's Name/
Partner's TIN

Capital Contribution
during the Period

Beginning Capital

Appraisal Capital

Share in Net Income (Loss)
Amount
%

Deduct Drawings/
Withdrawals

Ending Capital

200
200A

200B

200C

200D

200E

200F

200G

201A

201B

201C

201D

201E

201F

201G

202A

202B

202C

202D

202E

202F

202G

203A

203B

203C

203D

203E

203F

203G

204A

204B

204C

204D

204E

204F

204G

201

202

203

204 Total ( From Item 95 of Part III)
I declare, under the penalties of perjury, that this form/document has 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.
205
Taxpayer's Signature over Printed Name
Note: * Attach additional sheets to the Income Tax Returns and Account Information Forms, if necessary.

* If taxpayer's income is from long-term contracts, the tax return shall, likewise, be accompanied
by Certificates of Percentage of Completion during the taxable year of the projects performed
under the contracts to be signed by the Architect or Engineer.