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1914 Application for Tax Credits/Refunds

This BIR form is to be accomplished and filed by taxpayer applying for tax credits or refunds

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DLN:

BIR Form No.
Republika ng Pilipinas
Kagawaran ng Pananalapi

Kawanihan ng Rentas Internas

Application for Tax
Credits / Refunds

1914
January 2001

Fill in all applicable spaces. Mark all appropriate boxes with an "X"
Part I
1

Background Information

Taxpayer

1

2 Home RDO Code

2

Identification No.
3

Taxpayer's Name

3

4

Registered

4A

Address
4A

Zip Code

4B

Part II

Telephone Number 4C
Details of Tax Credits/Refunds

5

Tax Type

6

Period Covered

From

To

(MM/ DD/ YYYY)

6A

6B

7

Mode of Claim

7A

8

Claim Amount

8

5

Part III
9

7B

Tax Refund

Tax Credit Certificate

Reason for Filing

Reason for Filing the Claim
9A

Refunds or Tax Credits of Input Tax

9E

Expired TRN (Reissuance)

9B

Claim Arising from Special Laws / Tax Treaties

9F

Overpayment

9C

Claim Arising from Erroneous Payment of Taxes

9G

Regular Excise Claims

9D

Lost TRN (Replacement)

9H

Others (please specify)

Part IV

Legal Provision

10 Legal Basis

10

I declare, under the penalties of perjury, that this application has been made in good faith,
verified by me and to the best of my knowledge and belief, is true and correct, and that no
refund or tax credit involving the same tax has previously been claimed or received.

11

TAXPAYER'S SIGNATURE OVER PRINTED NAME

12

POSITION/TITLE

Stamp of Receiving Office
and Date of Receipt
 
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