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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.
