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0605-101 PAYMENT FORM FOR NO AUDIT PROGRAM (NAP)

This BIR form shall be used in making additional voluntary payment in compliance with the requirement of No Audit Program (NAP)

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DLN:

Payment Form

Republika ng Pilipinas
Kagawaran ng Pananalapi

BIR Form No.

0605-101

For No Audit Program
(NAP)

Kawanihan ng Rentas Internas

APRIL 2005

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

Date ( MM / DD / YYYY )

2 For the

Calendar

3 Tax Type

Fiscal

4 RDO Code

5 ATC

Year Ended
( MM/YYYY)

6

PSIC

7 Line of Business/Occupation

PSOC

Part I
8

Background

Information

Taxpayer Identification No.

9 Taxpayer Classification
I

10

Taxpayers
Name

NI

(Last Name, First Name, Middle Name for Individuals) / (Registered Name for Non-Individuals)

12 Registered
Address

13 Zip Code

Part II
14

11 Telephone No.

Computation
14

Total Amount of Payment

Voluntary Payment

Stamp of Receiving Office

This is to acknowledge that as part of our participation in the Bureau of Internal Revenue's
No Audit Program (NAP), the private sector is making an additional voluntary payment in
the amount specified in this form.

and Date of Receipt

It is understood that such additional payment is voluntarily made to meet the
growth ratio and ratio required for a taxpayer to be considered compliant with the
requirement of this program.
It is likewise, agreed that, no claims for refund or tax credit nor will the amount be deducted
from taxable income will be made in the future covering said additional voluntary payment.
I declare, under the penalties of perjury, that this 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.
15

Signature over Printed Name of Taxpayer /Authorized Representative
Part III

D e t a i l s of P a y m e n t

Particulars
16

Title/Position of Signatory

Drawee Bank/Agency
16A

Number
16B

17C

MM
16C

Machine Validation/Revenue Official Receipt Details (If not filed with the bank)

Taxpayer Classification:

I - Individual

N I - Non-Individual

DD

Amount

YY
16D
 
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