[NAME OF REGISTERED BUSINESS ENTITY]

ACTUAL INVESTMENTS AND BENEFITS FROM REGISTERED PROJECT/S

TAXABLE YEAR 2015

Registered Address / Zone Location: ________________________________________________________________________

Taxpayer Identification No. ________________________________________________________________________________
Revenue District Office No. ________________________________________________________________________________

ACTUAL INVES

DATE OF ASSETS
CR NO. REGISTERED ACTIVITY / IES
REGISTRATION NON-CURRENT ASSETS
CURRENT ASSETS OTHER NON-CURRENT
PPE (net)
ASSETS
(A) (B) (C) (D) (E) (F)

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 ACTUAL INVES

DATE OF ASSETS
CR NO. REGISTERED ACTIVITY / IES
REGISTRATION NON-CURRENT ASSETS
CURRENT ASSETS OTHER NON-CURRENT
PPE (net)
ASSETS

TOTAL - - -

Notes:
Value of Actual Investment, Salaries and Wages, and Other Benefits should be in Philippine Peso
Value of Actual Investment and Other Benefits should be as declared in the BIR Forms, AITR and/or AFS
Employment should be period ending 31 December 2015
Value of Salaries and Wages period covered January to December 2015

Certified true and correct: Noted by:

Signature over Printed Name Signature over Printed Name

Position/Designation Position/Designation

Date: _____________________

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 ACTUAL INVES

DATE OF ASSETS
CR NO. REGISTERED ACTIVITY / IES
REGISTRATION NON-CURRENT ASSETS
CURRENT ASSETS OTHER NON-CURRENT
PPE (net)
ASSETS

Reminders:

The excel worksheet should be certified by two (2) highest responsible officials of the enterprise by way of the attached certification,
the scanned copy of which shall be sent also by e-mail to esd@peza.gov.ph together with the Excel worksheet filled up.

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 ACTUAL INVESTMENT (Php)
% SHARE OF EQUITY
ASSETS STOCKHOLDER'S EQUITY OWNERSHIP
N-CURRENT ASSETS (% LOCAL AND %
TOTAL
RETAINED FOREIGN) ADMINISTRATIVE /
TOTAL STOCKHOLDER'S MANAGEMENT
TOTAL EARNINGS SALES
EQUITY

[(E+F) = G] [(D+G) = H] (I) (J) (K) (L) (M)

- -

- -

- -

- -

- -

- -

- -

- -

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 ACTUAL INVESTMENT (Php)
% SHARE OF EQUITY
ASSETS STOCKHOLDER'S EQUITY OWNERSHIP
N-CURRENT ASSETS (% LOCAL AND %
TOTAL
RETAINED FOREIGN) ADMINISTRATIVE /
TOTAL STOCKHOLDER'S MANAGEMENT
TOTAL EARNINGS SALES
EQUITY

- -

- - - - 0 0

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 EMPLOYMENT

MALE FEMALE

DIRECT INDIRECT OUTSOURCED EXPARTIATES ADMINISTRATIVE / DIRECT INDIRECT OUTSOURCED EXPARTIATES

TOTAL MANAGEMENT TOTAL
LABOR LABOR LABOR SALES LABOR LABOR LABOR

[(L+M+N+O+P+Q) [(S+T+U+V+W+X)
(N) (O) (P) (Q) = R] (S) (T) (U) (V) (W) (X) = Y]

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

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 EMPLOYMENT

MALE FEMALE

DIRECT INDIRECT OUTSOURCED EXPARTIATES ADMINISTRATIVE / DIRECT INDIRECT OUTSOURCED EXPARTIATES

TOTAL MANAGEMENT TOTAL
LABOR LABOR LABOR SALES LABOR LABOR LABOR

0 0

0 0 0 0 0 0 0 0 0 0 0 0

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 SALARIES AND WAGES / COMPENSATION PACKAGE (Php)

TOTAL ADMINISTRATIVE / DIRECT INDIRECT OUTSOURCED

MANAGEMENT EXPARTIATES TOTAL
SALES LABOR LABOR LABOR

[(AA+BB+CC+DD+EE+FF) =
[(R+Y) = Z] (AA) (BB) (CC) (DD) (EE) (FF) GG]

0 -

0 -

0 -

0 -

0 -

0 -

0 -

0 -

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 SALARIES AND WAGES / COMPENSATION PACKAGE (Php)

TOTAL ADMINISTRATIVE / DIRECT INDIRECT OUTSOURCED

MANAGEMENT EXPARTIATES TOTAL
SALES LABOR LABOR LABOR

0 -

0 - - - - - - -

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 ESD - TIMTA - FORM 01

OTHER BENEFITS FROM REGISTERED PROJECTS / OTHER TAXES (Php)

TAXES WITHHELD FINAL

REMITTED TO BIR LOCAL TAXES
OTHERS
WITHHOLDING TAX BUSINESS
WITHHOLDING TAX EXPANDED FINAL TAX WITHHELD REAL PROPERTY OCCUPATION
BY BANK/SOURCES (on TAXES /
ON COMPENSATION WITHHOLDING TAX interest income, etc.) (OTHER TAXES TAXES / OTHERS
NATIONAL TAXES, PERMITS
(FBT, etc.) ETC.)
(HH) (II) (JJ) (KK) (LL) (MM) (NN) (OO)

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 OTHER BENEFITS FROM REGISTERED PROJECTS / OTHER TAXES (Php)

TAXES WITHHELD FINAL

REMITTED TO BIR LOCAL TAXES
OTHERS
WITHHOLDING TAX BUSINESS
WITHHOLDING TAX EXPANDED FINAL TAX WITHHELD REAL PROPERTY OCCUPATION
BY BANK/SOURCES (on TAXES /
ON COMPENSATION WITHHOLDING TAX interest income, etc.) (OTHER TAXES TAXES / OTHERS
NATIONAL TAXES, PERMITS
(FBT, etc.) ETC.)

- - - - - - - -

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