0619-E Jan 2018 Rev Final-1-1-1
0619-E Jan 2018 Rev Final-1-1-1
0619-E Jan 2018 Rev Final-1-1-1
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Machine Validation/Revenue Official Receipt Details (if not filed with an Authorized Agent Bank) Stamp of Receiving Office/AAB and Date of Receipt
(RO’s Sign ature/Bank Teller’s Initial)
Republic of the Philippines Department of BIR Form No.
Finance Bureau of Internal Revenue Monthly Remittance Form *NOTE: Please read the BIR Data Privacy Policy found in the BIR website (www.bir.gov.ph)
1 For the Month of (MM/YYYY) 2 Due Date (MM/DD/YYYY) 3 Amended Form? 4 Any Taxes Withheld? 5 ATC 6 Tax Type Code
Yes No Yes No WME10 WE
0619-E 01/18 P1
Part I – Background Information
7 Taxpayer Identification Number (TIN) - - - 8 RDO Code
9 Withholding Agent’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)
10 Registered Address (Indicate complete address. If branch, indicate the branch address. If the registered address is different from the current address, go t o the RDO to update registered address by
15 Less: Amount Remitted from Previously Filed Form, if this is an amended form
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16 Net Amount of Remittance (Item 14 Less Item 15)
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17 Add: Penalties
17A Surcharge ●
17B Interest
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17C Compromise
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17D Total Penalties (Sum of Items 17A to 17C)
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18 Total Amount of Remittance (Sum of Items 16 and 17D)
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I/We declare under the penalties of perjury that this remittance form 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
to 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 information as contemplated under the
*Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes. (If Authorized Representative, attach authorization letter)
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For Individual: For Non-Individual:
20 Check
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