HSE Officer

For Compensation Payment With or Without Tax Withheld

Fill in all applicable spaces. Mark all appropriate boxes with an "X". 29

* ********'s Name (Last Name, First Name, Middle Name) 5 RDO Code 30 Holiday Pay (MWE)

6 Registered Address 6A ZIP Code

31 Overtime Pay (MWE)

32 Night Shift Differential (MWE)

6D Foreign Address

33 Hazard Pay (MWE)

7 Date of Birth (MM/DD/YYYY) 8 Contact Number

34

35 De Minimis Benefits

36

Minimum Wage Earner (MWE) whose compensation is exempt from withholding tax and not subject to income tax

12 TIN

39 Basic Salary

14 Registered Address 14A ZIP Code

40 Representation

41 Transportation

16 TIN

17 Employer's Name

44 Others (specify)

18 Registered Address 18A ZIP Code

SUPPLEMENTARY

19 Gross Compensation Income from Present 45 Commission Employer (Sum of Items 36 and 50)

20 Less: Total Non-Taxable/Exempt Compensation 46 Profit Sharing Income from Present Employer (From Item 36)

Taxable Compensation Income from Present 47 Fees Including Director's Fees Employer (Item 19 Less Item 20) (From Item 50)

Add: Taxable Compensation Income from 48 Taxable 13th Month Benefits Previous Employer, if applicable

Gross Taxable Compensation Income 49 Hazard Pay

(Sum of Items 21 and 22)

50 Overtime Pay

25 Amount of Taxes Withheld 51 Others (specify)

25A Present Employer

26

27

28

53 Date Signed

CONFORME:

54 Date Signed

Amount paid, if CTC

CTC/Valid ID No. Place of

of Employee Issue Date Issued

reported under BIR Form No. 1604-C which has been filed with the Bureau of Internal Revenue.

Form No. 2316 shall serve the same purpose as if BIR Form No. 1700 has been filed pursuant to the provisions 55

56

*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph) Employee Signature over Printed Name

the BIR Form No. 1604-C filed by my employer to the BIR shall constitute as my income tax return; and that BIR 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) 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

(BIR Form No. 1700), since I received purely compensation income from only one employer in the Philippines for the calendar year; that taxes have been correctly withheld by my employer (tax due equals tax withheld); that DENNIS H. CAMANAG

Employee Signature over Printed Name

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 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. ANNALYN G. CABILINO/Assistant Accounting Manager

Present Employer/Authorized Agent Signature over Printed Name Total Amount of Taxes Withheld as adjusted

(Sum of Items 25A and 25B)

7,884.93

52 Total Taxable Compensation Income

(Sum of Items 37 to 49B)

302,566.20

-

7,884.93

5% Tax Credit (PERA Act of 2008)

Total Taxes Withheld (Sum of Items 26 and 27)

25B Previous Employer, if applicable -

51B -

24 Tax Due

7,884.93 52,453.85

7,884.93

51A -

22 - -

23 302,566.20 -

338,625.02 -

36,058.82 -

21 302,566.20 -

44B

-

Part IVA - Summary

- 000

43 -

44A -

Fixed Housing Allowance

-

Part III - Employer Information (Previous)

- - 42 Cost of Living Allowance (COLA) -

15 Type of Employer X Main Employer Secondary Employer 13 Employer's Name B. TAXABLE COMPENSATION INCOME REGULAR JACOBS PROJECTS (PHILIPPINES), INC. 250,112.35

16F South Tower, Rockwell Business Center - Sheridan Sheridan St. cor United St. Barangay Highway Hills, Mandaluyong City - 38 Total Non-Taxable/Exempt Compensation Income (Sum of Items 27 to 35)

005 - 623 - 335 - 00000 36,058.82

11 37 Salaries and Other Forms of

Compensation

-

Part II - Employer Information (Present)

9 Statutory Minimum Wage rate per day (1,721.54)

10 Statutory Minimum Wage rate per month SSS, GSIS, PHIC & PAG-IBIG Contributions

15,634.77

-

08 03 1971 13th Month Pay and Other Benefits

(maximum of P90,000)

22,145.59

Dasmarinas City, PH 4114

-

6B Local Home Address 6C ZIP Code

-

000

Basic Salary (including the exempt P250,000 & below) or the Statutory Minimium Wage of the MWE

-

CAMANAG, DENNIS HEMBRADOR 041

-

3 TIN A. NON-TAXABLE/EXEMPT COMPENSATION INCOME Amount 150 - 725 - 526 -

03

(YYYY) From (MM/DD) To (MM/DD)

Part I - Employee Information Part IV-B Details of Compensation Income & Tax Withheld from Present Employer Republic of the Philippines

Department of Finance

Bureau of Internal Revenue

Certificate of Compensation

Payment/Tax Withheld

1 For the Year 2 For the Period

2 0 2 5 02 24 06

For BIR

Use Only

BCS/

Item:

2316

September 2021(ENCS)

BIR Form No.

2316 09/21ENCS

07 22 2025

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