SEQ NAME OF EMPLOYEES NATIONALITY/ CURRENT EMPLOYMENT REASON OF GROSS

NO (Last Name, First Name, Middle NameRESIDENT STATUS (*) EMPLOYMENT SEPARATION (**) COMPENSATION
(for foreigners only) From To INCOME
(present employer)
(1) (2a)(2b)(2c) (3) (4) (5a) (5b) (6) 7a=(7f+7j)
------------------------------------------------------- ----------------------------- ------------------------------ --------------------------------------------------------------------------------------------------------
1 ROCA, REYNALDO GEPANA FILIPINO 11/1/2023 12/31/2023 10,000.00
2 OLVEDA, GERLIE BELARMINO FILIPINO 1/1/2023 12/31/2023 22,000.00
3 ESPINA, MARVIN CARLOS FILIPINO 11/1/2023 12/31/2023 9,500.00
4 ESPINA, ROGELIO ORFALAS FILIPINO 1/1/2023 12/31/2023 22,000.00
5 CARLOS, SHIRLY ESPINA FILIPINO 1/1/2023 12/31/2023 22,000.00
6 PASTORAL, ANGELINA VISAYA FILIPINO 11/1/2023 12/31/2023 9,500.00
7 LABAO, JOSE PADOLINA FILIPINO 11/1/2023 12/31/2023 9,500.00
8 LLANTOS, JONALDO RETARDO FILIPINO 1/1/2023 12/31/2023 22,000.00
9 MAGABO, RENCIEL SANTIN FILIPINO 11/1/2023 12/31/2023 9,500.00
10 COMUNICAR, IRMA ASIA FILIPINO 1/1/2023 12/31/2023 22,000.00
11 GAMUZARAN, VERONICA RETARDO FILIPINO 1/1/2023 12/31/2023 22,000.00
12 ESPINA, RUEL ORFALAS FILIPINO 1/1/2023 10/31/2023 20,500.00
13 DELA PAZ, JAIME TAN FILIPINO 1/1/2023 10/31/2023 20,000.00
14 LACSON, NESTOR PERFINAN FILIPINO 1/1/2023 10/31/2023 20,000.00
15 ROBLES, LETECIA MAAS FILIPINO 1/1/2023 10/31/2023 20,000.00
16 ROALES, RELINA BASALLO FILIPINO 1/1/2023 10/31/2023 20,000.00
------------------
Grand Total : 280,500.00
==================
END OF REPORT
N O N - T A X A B L E T A X A B L E
13th MONTH PAY DE MINIMIS SSS, GSIS, PHIC & SALARIES (P250K & below) & TOTAL BASIC SALARY 13th MONTH PAY SALARIES & OTHER
& OTHER BENEFITS BENEFITS PAG-IBIG CONTRIBUTIONS OTHER FORMS OF NON-TAXABLE/EXEMPT (Net of SSS,GSIS,PHIC, & OTHER BENEFITS FORMS OF
AND UNION DUES COMPENSATION COMPENSATION INCOME HDMF Contri & Union Dues) (In excess of Threshold) COMPENSATION
(employees share only) (present employer)
(7b) (7c) (7d) (7e) 7f=(7b+7c+7d+7e) (7g) (7h) (7i)
------------------------------ -------------------- ------------------------------ ------------------------------ ------------------------------ ------------------------------ ------------------------------ ----------------------------
10,000.00 0.00 0.00 0.00 10,000.00 0.00 0.00 0.00
22,000.00 0.00 0.00 0.00 22,000.00 0.00 0.00 0.00
9,500.00 0.00 0.00 0.00 9,500.00 0.00 0.00 0.00
22,000.00 0.00 0.00 0.00 22,000.00 0.00 0.00 0.00
22,000.00 0.00 0.00 0.00 22,000.00 0.00 0.00 0.00
9,500.00 0.00 0.00 0.00 9,500.00 0.00 0.00 0.00
9,500.00 0.00 0.00 0.00 9,500.00 0.00 0.00 0.00
22,000.00 0.00 0.00 0.00 22,000.00 0.00 0.00 0.00
9,500.00 0.00 0.00 0.00 9,500.00 0.00 0.00 0.00
22,000.00 0.00 0.00 0.00 22,000.00 0.00 0.00 0.00
22,000.00 0.00 0.00 0.00 22,000.00 0.00 0.00 0.00
20,500.00 0.00 0.00 0.00 20,500.00 0.00 0.00 0.00
20,000.00 0.00 0.00 0.00 20,000.00 0.00 0.00 0.00
20,000.00 0.00 0.00 0.00 20,000.00 0.00 0.00 0.00
20,000.00 0.00 0.00 0.00 20,000.00 0.00 0.00 0.00
20,000.00 0.00 0.00 0.00 20,000.00 0.00 0.00 0.00
------------------ ------------------ ------------------ ------------------ ------------------ ------------------ ------------------ ------------------
280,500.00 0.00 0.00 0.00 280,500.00 0.00 0.00 0.00
================== =============================== ================== ================== ================== ================== ==================
 N O N - T A X A B L E
TOTAL TAXABLE TAXPAYER EMPLOYMENT PERIOD OF REASON OF GROSS 13th MONTH PAY DE MINIMIS
COMPENSATION INCOME IDENTIFICATION STATUS (*) EMPLOYMENT SEPARATION COMPENSATION & OTHER BENEFITS BENEFITS
(present employer) NUMBER From To , if applicable (**) PREVIOUS EMPLOYER

7j=(7g+7h+7i) (8) (9) (10a) (10b) (11) 12a=(12f+12j) (12b) (12c)

------------------------------ ------------------------------ ----------------------------------------------------------------------- -------------------------- ------------------------------ ------------------------------ -------------------
0.00 170-016-972-0000 11/1/2023 12/31/2023 0.00 0.00 0.00
0.00 323-974-425-0000 1/1/2023 12/31/2023 0.00 0.00 0.00
0.00 604-279-089-0000 11/1/2023 12/31/2023 0.00 0.00 0.00
0.00 935-051-378-0000 1/1/2023 12/31/2023 0.00 0.00 0.00
0.00 444-042-976-0000 1/1/2023 12/31/2023 0.00 0.00 0.00
0.00 444-429-764-0000 11/1/2023 12/31/2023 0.00 0.00 0.00
0.00 462-554-675-0000 11/1/2023 12/31/2023 0.00 0.00 0.00
0.00 460-795-958-0000 1/1/2023 12/31/2023 0.00 0.00 0.00
0.00 638-363-591-0000 11/1/2023 12/31/2023 0.00 0.00 0.00
0.00 460-795-704-0000 1/1/2023 12/31/2023 0.00 0.00 0.00
0.00 462-551-447-0000 1/1/2023 12/31/2023 0.00 0.00 0.00
0.00 192-933-122-0000 1/1/2023 10/31/2023 0.00 0.00 0.00
0.00 207-168-549-0000 1/1/2023 10/31/2023 0.00 0.00 0.00
0.00 287-452-061-0000 1/1/2023 10/31/2023 0.00 0.00 0.00
0.00 462-554-273-0000 1/1/2023 10/31/2023 0.00 0.00 0.00
0.00 452-447-903-0000 1/1/2023 10/31/2023 0.00 0.00 0.00
------------------ ------------------ ------------------ ------------------
0.00 0.00 0.00 0.00
================== ================== ================== ============
 T A X A B L E TOTAL TAXABLE TOTAL TAXABLE
SSS, GSIS, PHIC & SALARIES (P250K & below) & TOTAL NON-TAXABLE/ BASIC SALARY 13th MONTH PAY SALARIES & OTHER COMPENSATION COMPENSATION INCOME
PAG-IBIG CONTRIBUTIONS OTHER FORMS OF EXEMPT COMPENSATION (Net of SSS,GSIS,PHIC, & OTHER BENEFITS FORMS OF (previous employer) (Present and
AND UNION DUES COMPENSATION (Previous Employer) HDMF Contri & Union Dues) COMPENSATION Previous Employer)
(employees share only)
(12d) (12e) 12f=(12b+12c+12d+12e) (12g) (12h) (12i) 12j=(12g+12h+12i) 13=(7j+12j)
------------------------------------------------------------
------------------------------ ------------------------------ ------------------------------------------------------------------------------------- -----------------------------
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
------------------ ------------------ ------------------ ------------------ ------------------ ------------------ ------------------ ------------------
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
================== ================== ================== ================== ==================================== ================ ==================
 TAX WITHHELD Y E A R - E N D A D J U S T M E N T (16a or 16b)
TAX DUE (Jan. - Nov.) AMT WITHHELD OVER AMOUNT OF TAX SUBSTITUTED FILING
(Jan. - Dec.) PREVIOUS EMPLOYER PRESENT EMPLOYER & PAID FOR IN WITHHELD TAX WITHHELD AS YES/NO
DECEMBER or Last Salary REFUNDED TO ADJUSTED ***
EMPLOYEE
(14) (15a) (15b) 16a=14-(15a+15b) 16b=(15a+15b)-14 17=(15b+16a) OR (15b-16b) (18)
------------------- -------------------------------------------------------------------------------- ---------------------------------------------------- ------------------------------
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00
------------------ ------------------ ------------------ ------------------ ------------------ ------------------ ------------------
0.00 0.00 0.00 0.00 0.00 0.00 0.00
============================================================= ================================ ==================