ERD.2.F.001

REPUBLIC OF THE PHILIPPINES

Philippine Economic Zone Authority

APPLICATION FOR INCOME TAX HOLIDAY

(Availment of Income Tax Holiday Incentive)

For the taxable year ended ______

  1. INFORMATION ABOUT THE APPLICANT

Name of Company:

Tax Identification No. (TIN):

Official Address:

Telephone No.:

Authorized Representative:

Registration No:

Date of Registration:

Registered Activity:

Status (Please check): _____ Pioneer_____ Non-Pioneer

_____ Expansion

Start of commercial operation(SCO):

Committed (Per RA/SA/PFS) :

Actual(as attested by Zone Administrator/

Manger and/or PEZA approvedSCO

adjustment) :

Previous ITH applied

(indicate period, status :

approval no./date)

  1. PERPORMANCE DATA FOR TAXABLE YEAR

Volume Amount

A.Export Sales______P

B.Less: Base figure*______

C. Incremental Sales* ______

D.Rate of Exemption (C/A x 100)* ______%

E.Taxable IncomeP ______

F.Tax Due (E x tax rate**) ______

G. Income not subject to tax (D x E)* ______

H.Estimated income tax holiday (D x F) ______

RA - Registration Agreement

SA - Supplemental Agreement

PFS- Project Feasibility Study/ies

*For expansion and new projects with base figure only

**Regular Corporate Income Tax Rate

NAME OF COMPANY: ______

  1. CHECKLIST OF SUPPORTING DOCUMENTS

Documentary Requirements / Submitted
1 / Copy of complete Audited Financial Statements filed with the BIR (duly stamped “Received” by BIR)together with the ff:
  1. Segregated income statement per registered activity (if more than 1 registered activity) and/or interim income statement, if availment is for less than the 12 month period, duly certified by responsible official. For IT companies with multiple sites/locations, income statement should be segregated per site/location indicating the number of seats for each location.
  2. Breakdown/Details of other/miscellaneous income per project, if any (e.g., forex gain [realized/unrealized], scrap sales, interest income, income from unregistered activity etc.)duly certified by responsible official

2 / Copy of complete Income Tax Return filed with the BIR (duly stamped “Received” by BIR)
3 / Copy of Sales Summary with the following particulars: invoice no., date, volume/quantity, amount in US$ and its peso equivalent, buyer/destinationcertified by responsible official (per activity if more than 1 registered activity). Export and local sales should be segregated.
4 / Duly notarized sworn statement as to the start of commercial operation signed by responsible official and attested by Zone Manager
5 / Photocopy of official receipt of application fee (PhP1,200)

Done in ______this ______day of ______, 20 ___.

______

Signature ofAuthorized Signatory

Printed Name: ______

Designation/Position:______

REPUBLIC OF THE PHILIPPINES

______) S.S.

______)

SUBSCRIBED and SWORN to before me this ______day of ______, 20____

In the City/Province of ______. Affiant exhibited to me his/her Community tax No. ______issued at ______on ______, 20____

______

NOTARY PUBLIC

Doc. No. ______Until Dec. 31, 20______

Page No.______PTR No. ______

Book No. ______Issued at ______

Series of ______Issued on ______

Application for Income Tax Holiday

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