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DLN:
BIR Form No.
Certificate of Compensation
2316
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Payment/Tax Withheld
For Compensation Payment With or Without Tax Withheld July 2008 (ENCS)
Fill in all applicable spaces. Mark all appropriate boxes with an "X"
1 For the Year 2 For the Period
( YYYY ) 2022 From (MM/DD) 01 01 To (MM/DD) 12 31
Part I Employee Information Part IV-B Details of Compensation Income and Tax Withheld from Present Employer
3 Taxpayer Amount
Identification No. 419 194 438 000 A. NON-TAXABLE/EXEMPT COMPENSATION INCOME
4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code
32 Basic Salary/ 32
LOPEZ, KIMSON, GO 038 Statutory Minimum Wage
6 Registered Address 6A Zip Code Minimum Wage Earner (MWE)
C/O AC BENGSON JANITORIAL SERVICES 1008
33 Holiday Pay (MWE) 33
6B Local Home Address 6C Zip Code
34 Overtime Pay (MWE) 34
6D Foreign Address 6E Zip Code 35
35 Night Shift Differential (MWE)
7 Date of Birth (MM/DD/YYYY) 8 Telephone Number 36 Hazard Pay (MWE) 36
01 19 1970
37 13th Month Pay 37
9 Exemption Status and Other Benefits
45,000.00
Single Married
9A Is the wife claiming the additional exemption for qualified dependent children? 38 De Minimis Benefits 38
Yes No
10 Name of Qualified Dependent Children 11 Date of Birth (MM/DD/YYYY)
39 SSS, GSIS, PHIC & Pag-ibig 39
43,200.00
Contributions, & Union Dues
(Employee share only)
40 Salaries & Other Forms of 40
12 Statutory Minimum Wage rate per day 12 Compensation
13 Statutory Minimum Wage rate per month 13 41 Total Non-Taxable/Exempt 41 88,200.00
Compensation Income
14 Minimum Wage Earner whose compensation is exempt from
withholding tax and not subject to income tax B. TAXABLE COMPENSATION INCOME
Part II Employer Information (Present) REGULAR
15 Taxpayer
Identification No. 429 368 609 0000 42 Basic Salary 42 540,000.00
16 Employer's Name
43
ACBENGSON JANITORIAL SERVICES 43 Representation
17 Registered Address 17A Zip Code
44 Transportation 44
21 KALAYAAN AVE., CENTRAL, QUEZON CITY 1008
Main Employer Secondary Employer 45 Cost of Living Allowance 45
Part III Employer Information (Previous)
18 Taxpayer 46 Fixed Housing Allowance 46
Identification No.
19 Employer's Name 47 Others (Specify)
47A 47A
20 Registered Address 20A Zip Code 47B 47B
SUPPLEMENTARY
Part IV-A Summary 48 Commission 48
21 Gross Compensation Income from 21
Present Employer (Item 41 plus Item 55) 628,200.00
22 Less: Total Non-Taxable/ 22 49 Profit Sharing 49
Exempt (Item 41) 88,200.00
23 Taxable Compensation Income 23
from Present Employer (Item 55) 540,000.00 50 Fees Including Director's 50
24 Add: Taxable Compensation 24 Fees
Income from Previous Employer 0.00
25 Gross Taxable 25 51 Taxable 13th Month Pay 51
Compensation Income 540,000.00 and Other Benefits
26 Less: Total Exemptions 26
0.00 52 Hazard Pay 52
27 Less: Premium Paid on Health 27
and/or Hospital Insurance (If applicable) 0.00
28 Net Taxable 28 53 Overtime Pay 53
Compensation Income 540,000.00
29 Tax Due 29 54 Others (Specify)
74,000.00
30 Amount of Taxes Withheld 54A 54A
30A Present Employer 30A 74,000.00
54B 54B
30B Previous Employer 30B 0.00
55 Total Taxable Compensation 55
31 Total Amount of Taxes Withheld 31 74,000.00 540,000.00
As adjusted Income
We declare, under the penalties of perjury, that this certificate has been made in good faith, verified by us, and to the best of 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.
56 TEOFILA M. RAMOS Date Signed
03 07 2023
Present Employer/ Authorized Agent Signature Over Printed Name
CONFORME:
57 KIMSON GO LOPEZ Date Signed
03 07 2023
CTC No. Employee Signature Over Printed Name Amount Paid
of Employee Place of Issue Date of Issue 20197
To be accomplished under substituted filing
I declare, under the penalties of perjury, that the information herein stated are reported I declare,under the penalties of perjury that I am qualified under substituted filing of
under BIR Form No. 1604CF which has been filed with the Bureau of Internal Revenue. Income Tax Returns(BIR Form No. 1700), since I received purely compensation income
from only one employer in the Phils. for the calendar year; that taxes have been
correctly withheld by my employer (tax due equals tax withheld); that the BIR Form
58 JUANA MATILDE J. ADAZA No. 1604CF filed by my employer to the BIR shall constitute as my income tax return;
Present Employer/ Authorized Agent Signature Over Printed Name and that BIR Form No. 2316 shall serve the same purpose as if BIR Form No. 1700
(Head of Accounting/ Human Resource or Authorized Representative) had been filed pursuant to the provisions of RR No. 3-2002, as amended.
59 VIOLETA VHESUNG ZALZAL
Employee Signature Over Printed Name
