DESO, Poll Clerk, 3rd Member

Republic of the Philippines

For BIR BCS/ Department of Finance
Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Compensation
2316
January 2018 (ENCS)
Payment/Tax Withheld
For Compensation Payment With or Without Tax Withheld 2316 01/18ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".
1 For the Year 2 For the Period
(YYYY) 2 0 2 2 From (MM/DD) 0 5 0 1 To (MM/DD) 0 5 3 1
Part I - Employee Information Part IV-B Details of Compensation Income & Tax Withheld from Present Employer
3 TIN
176 - 499 - 906 - A. NON-TAXABLE/EXEMPT COMPENSATION INCOME Amount

4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code 27 Basic Salary (including the exempt P250,000 & below)
or the Statutory Minimum Wage of the MWE
LOPEZ, CANDICE U.
28 Holiday Pay (MWE)
6 Registered Address 6A ZIP Code

ADUAS, PANIQUI, TARLAC 2307 29 Overtime Pay (MWE)

6B Local Home Address 6C ZIP Code
30 Night Shift Differential (MWE)
ADUAS, PANIQUI, TARLAC 2307
6D Foreign Address
31 Hazard Pay (MWE)

32 13th Month Pay and Other Benefits

7 Date of Birth (MM/DD/YYYY) 8 Contact Number (maximum of P90,000)

01 05 19 75 09 4 5 5 6 4 1 7 74 33 De Minimis Benefits
9 Statutory Minimum Wage rate per day 34 SSS, GSIS, PHIC & PAG-IBIG Contributions
and Union Dues (Employee share only)
10 Statutory Minimum Wage rate per month
35 Salaries and Other Forms of Compensation
Minimum Wage Earner (MWE) whose compensation is exempt from
11
withholding tax and not subject to income tax 36 Total Non-Taxable/Exempt Compensation
Part II - Employer Information (Present) Income (Sum of Items 27 to 35)
12 TIN
000 - 7 51 - 960 - 000 B. TAXABLE COMPENSATION INCOME REGULAR

13 Employer's Name
37 Basic Salary
COMMISSION ON ELECTIONS
14 Registered Address 14A ZIP Code 38 Representation

39 Transportation
15 Type of Employer Main Employer Secondary Employer
40 Cost of Living Allowance (COLA)
Part III - Employer Information (Previous)
16 TIN
- - - 41 Fixed Housing Allowance

17 Employer's Name 42 Others (specify)

42A
18 Registered Address 18A ZIP Code
42B
SUPPLEMENTARY
Part IVA - Summary
43 Commission
19 Gross Compensation Income from Present
Employer (Sum of Items 36 and 50) 6,000.00
44 Profit Sharing
20 Less: Total Non-Taxable/Exempt Compensation
Income from Present Employer (From Item 36)
45 Fees Including Director's Fees
21 Taxable Compensation Income from Present
Employer (Item 19 Less Item 20) (From Item 50) 6,000.00
46 Taxable 13th Month Benefits
22 Add: Taxable Compensation Income from
Previous Employer, if applicable
47 Hazard Pay
23 Gross Taxable Compensation Income
(Sum of Items 21 and 22) 6,000.00
48 Overtime Pay
24 Tax Due 1,200.00 49 Others (specify)
25 Amount of Taxes Withheld
1,200.00 49A
25A Present Employer COMELEC Compensation 6,000.00
25B Previous Employer, if applicable 49B

26 Total Amount of Taxes Withheld as adjusted 50 Total Taxable Compensation Income

(Sum of Items 25A and 25B) 1,200.00 (Sum of Items 37 to 49B) 6,000.00
I/We declare, under the penalties of perjury that this certificate has been made in good faith, verified by me/us, and to the best of my/our knowledge and belief, is true and correct, pursuant
the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. Further, I/we give my/our consent to the processing of my/our informati
as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

51 ROSARION B. SOBERANO Date Signed

Present Employer/Authorized Agent Signature over Printed Name
CONFORME:
52 CANDICE U. LOPEZ Date Signed
Employee Signature over Printed Name Amount paid, if CTC
CTC/Valid ID No. Place of
Paniqui, Tarlac Date Issued
of Employee 26154213 Issue 293.00
To be accomplished under substituted filing
I declare, under the penalties of perjury that the information herein stated are I declare, under the penalties of perjury that I am qualified under substituted filing of Income Tax Return
reported under BIR Form No. 1604-C which has been filed with the Bureau of (BIR Form No. 1700), since I received purely compensation income from only one employer in the Philippines
Internal Revenue. for the calendar year; that taxes have been correctly withheld by my employer (tax due equals tax withheld); that
the BIR Form No. 1604-C filed by my employer to the BIR shall constitute as my income tax return; and that BIR
Form No. 2316 shall serve the same purpose as if BIR Form No. 1700 has been filed pursuant to the provisions
53 ROSARION B. SOBERANO of Revenue Regulations (RR) No. 3-2002, as amended.
Present Employer/Authorized Agent Signature over Printed Name
(Head of Accounting/Human Resource or Authorized Representative) 54 CANDICE U. LOPEZ
Employee Signature over Printed Name
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)