Republic of the Philippines

Department of Finance
BUREAU OF INTERNAL REVENUE
Quezon City

APPLICATION FOR TAX CLEARANCE

(Individual / Sole Proprietor)

I, ___________________________ Filipino (Indicate nationality for non-Filipino citizenship) of

legal age, single/married to permanently residing at ____________________________________
with Tax Identification Number (TIN) _____________________ after been duly sworn in accordance with law hereby depose and
state:

1 That I am the Owner/Proprietor/Proprietress of _______________________________________________________

with business address ______________________________________________________ with Telephone/Cellular
Phone No. ________________ and email address _______________.

2 That my business trade name has been duly registered with the Department of Trade and Industry on
. _________________ under DTI registration Certificate No. _________

3 That I registered my business with BIR under Certificate of Registration OCN No. ____________________.
Issued at Revenue District Office No. _________ on ________________.

4 That this APPLICATION FOR TAX CLEARANCE is being submitted in order to secure a Tax Clearance Certificate for
entering into any contract with the Government/Private Agencies requiring the same under Executive Order No. 398 as
Implemented by RR No. 3-2005.

5 Purpose _________________________

Signature over Printed Name of Applicant/Representative

PROPERLY FILL UP THIS APPLICATION FORM & ATTACH THE FOLLOWING REQUIREMENTS:

a. Written request for TCC addressed to the TCC processing office with the following information.
(1) Name of the taxpayer requesting the tax clearance;
(2) Address and contact number (i.e. telephone/fax number);
(3) Taxpayer Identification Number (TIN);
(4) Revenue District Office having jurisdiction over the taxpayer;
(5) Name of the Procuring Government Agency;
(6) Name of the responsible procurement officer and his contact number (i.e. telephone/fax number)

b. Duly filled-up and notarized Application Form for Tax Clearance duly affixed with the prescribed documentary stamp.
c. Delinquency Verification Form duly issued by the Collection Enforcement Division (CED) and Revenue District Office
(RDO) having jurisdiction over the taxpayer-applicant;
d. Certified true copy of Certificate of registration (BIR Form No. 2303) for FIRST-TIME applicant only)
e. Proof of Enrollment to the BIR’s Electronic Filling and Payment System (eFPS) facility pursuant to Revenue Regulations
(RR) No. 3-2005, activation of the eFPS account and actual utilization of the filling and payment Facility.
f. Photocopy of Previous Tax Clearance Certificate issued (for RENEWAL);
g. Authorization letter, if filed by a representative and two valid ID’s;
h. Photocopy of the Registration Certificate issued by the department of Trade and Industry (DTI) (for FIRST-TIME applicant
only);
i. Certification Fee P 100 paid thru eFPS;
j. Documentary Stamp P15.00 (1pc) to be affixed to the tax clearance to be issued; and
k. Other documents as may be required by the concerned processing/proving office.

If taxpayer has outstanding tax liability/ies, hereunder are the additional requirements, If applicable:

l. Copy of the Final Assessment Notice (FAN) and/or Final Decision on Disputed Assessment (FDDA) issued by the
Commissioner or his duly designated representative;
m. Duly filed Noticed of Availment of Tax Amnesty, Tax Amnesty Return (BIR Form No. 2116) and the corresponding
Payment Form (BIR Form No. 0617) as proof of payment thereof, in case of availment of the Tax Amnesty Program (for
FIRST-TIME applicant);
n. Copy of the formal letter request and photocopy of Application for Compromise Settlement or Application for Abatement or
Cancellation of Tax Penalties and/or Interest Under Revenue Regulations Nos. 13-2001 or 15-2006 (BIR Form No. 2110)
duly received by the concerned Revenue District Office (RDO);
o. Copy of duly validated Payment Form (BIR Form 0605), Official Receipt issued by Authorized Agent Bank (AAB) or
Revenue Official Receipt (BIR Form No. 2524) issued by Revenue Collection Officer, whichever is applicable,
representing Payment of Compromise/Abatement Offer;
p. Copy of the Letter of Protest, Request for Reconsideration and/or Reinvestigation duly filed by the taxpayer with the
concerned BIR office;
q. In case of installment payment, a copy of the approved letter-request for installment payment; and
r. Other documents as may be required by the concerned processing/approving office.

SUBSCRIBE AND SWORN to before me this day of 2016 in applicant

exhibited to me his/her Community Tax Certificate No ______________ issued at ______________________ on
___________ .

Doc. No. __________

Page No. __________ Notary Public
Book No. __________
Series of 2016

Affix
P15.00
Documentary Stamp Tax