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Acceptance Payment Form: Tax Amnesty On Delinquencies

This document is an Acceptance Payment Form for tax amnesty on delinquencies pursuant to Republic Act No. 11213. It provides instructions for taxpayers to pay their tax amnesty amount as determined on BIR Form No. 2118-DA. The form collects taxpayer identification and contact information. It shows the tax amnesty amount from Form 2118-DA and includes spaces for payment details such as payment method, bank, check number, and amount. Instructions specify that the form should be filed with the Authorized Agent Bank under the taxpayer's Revenue District Office or with the RCO if no bank is available, and include validation steps for the bank.

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163 views1 page

Acceptance Payment Form: Tax Amnesty On Delinquencies

This document is an Acceptance Payment Form for tax amnesty on delinquencies pursuant to Republic Act No. 11213. It provides instructions for taxpayers to pay their tax amnesty amount as determined on BIR Form No. 2118-DA. The form collects taxpayer identification and contact information. It shows the tax amnesty amount from Form 2118-DA and includes spaces for payment details such as payment method, bank, check number, and amount. Instructions specify that the form should be filed with the Authorized Agent Bank under the taxpayer's Revenue District Office or with the RCO if no bank is available, and include validation steps for the bank.

Uploaded by

JennyMariedeLeon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

For BIR BCS/ Department of Finance


Use Only Item: Bureau of Internal Revenue

BIR Form No. Acceptance Payment Form


0621-DA Tax Amnesty on Delinquencies
March 2019 Pursuant to Republic Act No. 11213
Enter all required information in CAPITAL LETTERS using BLACK ink. Mark all applicable boxes with an “X”. 0621-DA 03/19
1 Date File (MM/DD/YYYY) 2 Tax Type MC 3 ATC MC 330 4 Number of Sheet/s Attached

Part I – Taxpayer Information


5 Taxpayer Identification Number (TIN) / / / 6 RDO Code
7 Taxpayer/Filer’s Name (Last Name, First Name, Middle Name for Individual OR Registered Name for Non-Individual)

8 Registered Address (Indicate complete address. If branch, indicate the branch address. If the registered address is different from the current address, go to the RDO to update registered address by using BIR Form No. 1905)

8A ZIP Code

9 Email Address

Part II – Tax Amnesty Amount


10 Tax Amnesty Amount [Lifted from Tax Amnesty Return (BIR Form No. 2118-DA) Part II, Item 15] ●
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 For payment of Tax Amnesty on Delinquencies
amended, and the regulations issued under authority thereof. Further, I/we give my 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. ENDORSED BY:
(If Authorized Representative, attach authorization letter and indicate TIN)
For Individual: For Non-Individual:

Signature over Printed Name of Taxpayer/Authorized Signature over Printed Name of President/Vice President/
Representative/Tax Agent Authorized Officer or Representative/Tax Agent
(indicate title/designation and TIN) (indicate title/designation and TIN)
Tax Agent Accreditation No./ Date of Issue Date of Expiry Revenue District Officer
Attorney’s Roll No. (if applicable) (MM/DD/YYYY) (MM/DD/YYYY) (Signature over Printed Name)
Part III – Details of Payment
Particulars Drawee Bank/Agency Number Date (MM/DD/YYYY) Amount
11 Cash/Bank Debit Memo ●
12 Check ●
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 Signature/Bank Teller’s Initial)

*NOTE: The BIR Data Privacy Policy is in the BIR website (www.bir.gov.ph)

Guidelines and Instructions:


Where to Pay

This Acceptance Payment Form Tax Amnesty on Delinquencies shall be accomplished in four (4) copies [two (2) for the collecting agent, the 3rd and 4th copies;
and two (2) for the taxpayer, original and duplicate). The amount payable shall be paid with the Authorized Agent Bank (AAB) under the Revenue District Office (RDO)
having jurisdiction over the taxpayer’s place of business/office. In places where there is no AAB, the form shall be filed and the tax paid with the Revenue Collection
Officer (RCO) of the RDO having jurisdiction over the taxpayer’s place of business/office, who will issue an Electronic Revenue Official Receipt (eROR) therefor or
manually-issued ROR.

When the return is filed with an AAB, taxpayer must accomplish and submit BIR-prescribed deposit slip, which the bank teller shall machine validate as evidence
that payment was received by the AAB. The AAB receiving the form shall stamp mark the word “Received” on the form and also machine validate the form as proof of
filing and payment of the tax by the taxpayer. The machine validation shall reflect the date of payment, amount paid and transactions code, the name of the bank, branch
code, teller’s code and teller’s initial. Bank debit memo number and date should be indicated in the form for taxpayers paying under the bank debit system.

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