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617 Tax Amnesty Payment Form (Acceptance of Payment Form) For Taxable Year 2005 and Prior Years Pursuant to Republic Act No. 9480

This form shall be filed in quadruplicate by Individuals, whether resident or nonresident citizens, or resident or nonresident aliens, Estates, Trusts, Corporations, Cooperatives and tax exempt entities that have become taxable as of December 31, 2005 and other juridical entities including partnerships liable to pay any internal revenue taxes covering the taxable year ending December 31, 2005 and prior years, availing the Tax Amnesty under R.A. No. 9480.

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BIR Form No.

Tax Amnesty Payment Form

Republika ng Pilipinas
Kagawaran ng Pananalapi

0617

(Acceptance of Payment Form)

Kawanihan ng Rentas Internas

For Taxable Year 2005 and Prior Years
Pursuant to Republic Act No. 9480

August 2007(ENCS)

Fill in all applicable spaces. Mark all appropriate boxes with an "X"
Date Filed ( MM / DD / YYYY )

1

2 Tax Type Code

M C

3 ATC

Tax Type Description

4 No. of Sheets
Attached

MC 300

Tax Amnesty

BCS No./Item No. (To be filled up by the BIR)

5

Part I
6 Taxpayer Identification Number

Background Information
7 RDO Code
8 Taxpayer Classification
I

10

9 Line of Business

N

Taxpayer's

11 Telephone Number

Name
(Last Name, First Name, Middle Name for Individuals) / (Registered Name for Non-Individuals)
12 Business/
Trade Name
13 Registered
Address
15 Manner of

14 Zip Code
16 Type of Payment

SPF (Tax Amnesty Program)

Payment
Part II

Full Payment

Computation of Tax Amnesty Payment
Without Previous
With Previous
SALN/Balance Sheet
SALN/Balance Sheet
TAXPAYERS

(taxable base is networth
as declared in the SALN

(taxable base is
increase in networth)

Minimum Absolute
Amount

as of December 31,2005)

A
Individuals (whether resident or nonresident
citizens, including resident or nonresident aliens),
Estates and Trusts

17

C

D

E
50,000.00

500,000.00
250,000.00
100,000.00

iv. With subscribed capital of below P 5 million

25,000.00

Other juridical entities, including partnerships, but
not limited to, cooperatives and foundations, that
have become taxable as of December 31, 2005

50,000.00

20 Tax Amnesty Payable (amount reflected in column E above)
21

amount between
(B & D)/(C & D)
whichever is applicable

B

18 Corporations
i. With subscribed capital of above P 50 million
ii. With subscribed capital of above P 20 million
up to P 50 million
iii. With subscribed capital of P 5 million up to
P 20 million

19

Tax Amnesty
Payment (higher

20A

I declare, under the penalties of perjury, that this document has been made in good faith, verified by me,
and is true and correct, pursuant to the provisions of existing regulations implementing R.A. No. 9480.

Signature over Printed Name of Taxpayer /Authorized Representative
Title/Position of Signatory
President/Vice President/Principal Officer/

TIN of Signatory
Collection Agent/Treasurer/
Branch Manager/Asst. Branch Manager
(Signature Over Printed Name)

Authorized Representative/Taxpayer
(Signature Over Printed Name)
Part III

Stamp of Receiving Office/
AAB and Date of Receipt

D e t a i l s of P a y m e n t

Particulars
Drawee Bank/Agency
22 Cash/
22A
22B

Number

MM

DD

YYYY

Amount

22C

22D

23C

23D

24C

24D

Bank Debit Memo

23 Check 23A

23B

24 Others 24A

24B

17C

19C
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)

Taxpayer Classification: I - Individual

N - Non-Individual

(Note: Please see back portion for guidelines and instructions)

BIR Form No. 0617 – Tax Amnesty Payment Form
Guidelines and Instructions

Who Shall Use This Form
Individuals, whether resident or nonresident citizens, or resident or nonresident aliens,
Estates, Trusts, Corporations, Cooperatives and tax exempt entities that have become taxable as
of December 31, 2005 and other juridical entities including partnerships liable to pay any
internal revenue taxes covering the taxable year ending December 31, 2005 and prior years,
availing the Tax Amnesty under R.A. No. 9480 shall use this form.

Where to File and Pay
This form shall be filed in quadruplicate and the payment of amnesty tax shall be made to
any Authorized Agent Bank (AAB) under the jurisdiction of the Revenue District Office/Large
Taxpayers District Office where the legal residence or principal place of business of the taxpayer
is registered or required to be registered. In places where there are no AABs, this form shall be
filed and the tax shall be paid to the Reve nue Collection Officer or duly Authorized City or
Municipal Treasurer of the Revenue District Office where the taxpayer is registered or required
to be registered. The Revenue Collection Officer or duly Authorized City or Municipal Treasurer
shall issue a Revenue Official Receipt (ROR) therefor.
Where this form is filed with an AAB, the taxpayer must accomplish and submit BIRprescribed deposit slip, which the bank teller shall machine validate as evidence that payment
was received by the AAB. The AAB shall stamp mark this form with the word “Received” and
also machine validate it as proof of receipt of the Tax Amnesty Payment of the taxpayer. The
machine validation shall reflect the date of payment, amount paid and transactions code, the
name of the bank, branch code, teller’s code and teller’s initial. Bank debit memo number and
date should be indicated in the form for taxpayers paying under the bank debit system.

NOTE:
•
•
•

All background information must be properly filled up.
Tax Credit Certificate (TCC), Tax Debit Memo (TDM) and Creditable Withholding
Tax Certificate are not allowed as payment.
Payment should be in cash or cash equivalent (e.g. Manager’s check, Cashier’s
Check)
 
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