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1915 Application for Tax Credit Certificate Utilization

This BIR form is to be accomplished and filed by taxpayer applying for tax credits certificate utilization.

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DLN:

Republika ng Pilipinas
Kagawaran ng Pananalapi

Kawanihan ng Rentas Internas

Application for Tax
Credit Certificate Utilization

BIR Form No.

1915
January 2001

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

Background Information
2 Home RDO Code

1

2

Identification No.
3

Taxpayer's Name

3

4

Registered

4A

Address
4A

Zip Code
Part II
5

4B

Telephone Number 4C
Details of Utilization

Issuance of TDM for BIR taxes
Serial Number of TCC used
5A

5D TDM Amount
5E Tax type

5B TDM Issuing Office (BIR Office)

5F Period Covered/Ending
(MM/DD/YYYY)

5C TDM Receiving Office (BIR Office)
Conversion to Refund

6

Serial Number of TCC
To be converted to refund

6A

Reason for conversion

6B

I declare, under the penalties of perjury, that this request has been made in good faith,
verified by me and to the best of my knowledge and belief, is true and correct, and
that all accompanying documents, if any, are valid.

7

TAXPAYER'S SIGNATURE OVER PRINTED NAME

TO BE FILLED UP BY THE BIR:
APPROVED / DISAPPROVED

DATE
(MM/DD/YYYY)

OFFICER IN CHARGE

REASON, IF DISAPPROVED

Stamp of Receiving Office
and Date of Receipt
 
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