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0611-A Payment Form Covered by a Letter Notice

This BIR form shall be used by any person, natural or juridical, including estates and trusts, who are issued Letter Notices generated through the following third-party information (TPI)data matching programs- 1. Reconciliation of Listings for Enforcement (RELIEF)/Bureau of Customs (BOC) Data Program; and 2. Tax Reconciliation Systems (TRS).

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Use Only

BCS/
Item

0611-A10/14ENCSP1

1 For the

Calendar

Covered by a Letter Notice
Enter all required information in CAPITAL LETTERS using black ink. Mark all applicable
boxes with an “X”. Two copies must be filed with the BIR and one held by the taxpayer

Fiscal

4 Return Period (MM/DD/YYYY)

BIR Form No.

PAYMENT FORM

Republic of the Philippines
Department of Finance
Bureau of Internal Revenue

2 Year Ended
(MM/YYYY)

0611-A
October 2014 (ENCS)

3 Number of Sheet/s Attached

5 Alphanumeric Tax Code (ATC)

6 Tax Type Code

7 Taxpayer Classification
Individual

Non-Individual

Part I – Background Information

-

8 Taxpayer Identification Number (TIN)

-

-

9 RDO Code

10 Taxpayer’s Name (Last Name, First Name, Middle Name for Individual)/(Registered Name for Non-Individual)
11 Trade Name
12 Registered Address (indicate complete registered address)

12A ZIP Code
13 Contact Number

14 Email Address

15 Main Line of Business

16 PSIC

18 Type of Payment
Full
Payment

17 PSOC

19 Letter Notice Number

-

Installment Payment
1st Installment

2nd Installment

Subsequent installment after the

3rd

3rd Installment

-

-

installment (specify the number)

Part II – Computation of Payable
20 Basic Tax

●

21 Add: Penalties 21A Surcharge

●

21B Interest

●

21C Compromise

●

21D Total Penalties (Sum of Items 21A to 21C)

●

22 Total Amount Payable (Sum of Items 20 and 21D)

●

We declare under the penalties of perjury, that this return has been made in good faith, verified by us, and to the best of our 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. (If Authorized Representative, attach authorization letter).

Signature over Printed Name of President/Principal Officer/Authorized
Signature over Printed Name of Treasurer/Assistant Treasurer
Representative/Taxpayer (indicate title and TIN)
(indicate title and TIN)
Tax Agent Acc. No./
Date of Issuance
Expiry Date
(MM/DD/YYYY)
(MM/DD/YYYY)
Atty’s Roll No. (if applicable)

Part III –Details of Payment
Particulars

Drawee Bank/
Agency

Number

Date (MM/DD/YYYY)

23 Cash/Bank
Debit Memo

24 Check
25 Tax Debit Memo

Amount
●
●
●

26 Others (specify below)
●

Machine Validation/Revenue Official Receipt (ROR) Details (if not filed with an Authorized Agent Bank)

Stamp of receiving Office/AAB and Date of Receipt
(RO’s Signature/Bank Teller’s Initial)

Guidelines and Instruction for BIR Form No. 0611-A [October 2014 (ENCS)]
Payment Form Covered by a Letter Notice
Who Shall Use This Form
This form shall be used by any person, natural or juridical, including estates and trusts, who are issued Letter Notices generated
through the following third-party information (TPI) data matching programs:
1. Reconciliation of Listings for Enforcement (RELIEF)/Bureau of Customs (BOC) Data Program; and
2. Tax Reconciliation Systems (TRS).
The PDF format of the payment form is available for download through the Bureau of Internal Revenue (BIR) website
www.bir.gov.ph.

Where to File and Pay
This form shall be filed and the tax shall be paid with any Authorized Agent Bank (AAB) and/or thru Electronic Filing and Payment
System (eFPS) under the jurisdiction of the Revenue District Office (RDO)/Large Taxpayers Division/Large Taxpayers District Office
where the taxpayer (head office of the taxpayer) is registered or required to be registered and file a return.
For filing and payment with an AAB, taxpayer must accomplished and submit BIR-prescribed deposit slip which the bank teller
shall machine validate as evidence that the BIR tax payment was deposited to the account of the Bureau of Treasury. The AAB receiving
the payment form shall also machine validate and stamp mark the word “Received” on the payment form as proof of filing and payment
of the tax by 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 advice/memo shall still be issued to taxpayers paying under the bank
debit system.
In places where there are no AABs, this form shall be filed and the tax shall be paid to the Revenue Collection Officer (RCO) or
duly authorized City or Municipal Treasurer of the RDO where the taxpayer is registered or required to be registered. The RCO or duly
authorized City or Municipal Treasurer shall issue a Revenue Official Receipt (ROR) therefor.
For payment thru eFPS, taxpayer must pay the tax liability through the internet banking facilities of the AABs, via debit from their
enrolled bank account.
The form shall be in triplicate copies and distributed as follows:
Original
Duplicate
Triplicate

-

Taxpayer’s Copy
Bank’s Copy
Revenue District Office’s Copy

NOTE:
This form shall be accomplished per tax type.
The applicable tax type code under Item No. 6 and alphanumeric tax code (ATC) under Item No. 5 of this form shall be:
Tax Type Code
IT
VT
WC
WE
PT
PM
MC

Type of Tax
Income Tax
Value-Added Tax
Withholding Tax - Compensation
Withholding Tax – Expanded
Percentage Tax – Quarterly
Percentage Tax – Monthly
Mandatory Compromise Penalty

ATC
MC 250
MC 251
MC 254
MC 255
MC 265
MC 266
MC 200
 
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