Republic of the Philippines

For BIR BCS/ Department of Finance

Use Only Item: Bureau of Internal Revenue
BIR Form No.
Certificate of Compensation
2316
September 2021(ENCS)
Payment/Tax Withheld
For Compensation Payment With or Without Tax Withheld 2316 9/21ENCS
Fill in all applicable spaces. Mark all appropriate boxes with an "X".
1 For the Year 2 For the Period
(YYYY) 2 0 2 3 From (MM/DD) 01 0 1 To (MM/DD) 12 31
Part I - Employee Information Part IV-B Details of Compensation Income & Tax Withheld from Present Employer
3 TIN
001 - 000 - 000 - 0 0 0 0 0 A. NON-TAXABLE/EXEMPT COMPENSATION INCOME Amount

4 Employee's Name (Last Name, First Name, Middle Name) 5 RDO Code 29 Basic Salary (including the exempt P250,000 & below)
or the Statutory Minimum Wage of the MWE 83,633.10
HERNANDEZ, MARLON, L 027
30 Holiday Pay (MWE)
6 Registered Address 6A ZIP Code

CALOOCAN CITY. 31 Overtime Pay (MWE)

6B Local Home Address 6C ZIP Code
32 Night Shift Differential (MWE)

6D Foreign Address
33 Hazard Pay (MWE)

34 13th Month Pay and Other Benefits

7 Date of Birth (MM/DD/YYYY) 8 Contact Number (maximum of P90,000) 7,500.00
09 26 1984 35 De Minimis Benefits
9 Statutory Minimum Wage rate per day 36 SSS, GSIS, PHIC & PAG-IBIG Contributions
and Union Dues (Employee share only) 6,366.90
10 Statutory Minimum Wage rate per month
37 Salaries and Other Forms of Compensation
Minimum Wage Earner (MWE) whose compensation is exempt from
11
withholding tax and not subject to income tax 38 Total Non-Taxable/Exempt Compensation
Part II - Employer Information (Present) Income (Sum of Items 29 to 37) 97,500.00
12 TIN
260 - 366 - 175 - 00000 B. TAXABLE COMPENSATION INCOME REGULAR

13 Employer's Name
39 Basic Salary
MARLA'S BAKESHOPPE
14 Registered Address 14A ZIP Code 40 Representation
101 C NAMIECOR 2ND AVENUE, BRGY. 043 DIST. 2 CALOOCAN
CITY. 41 Transportation
15 Type of Employer Main Employer Secondary Employer
X 42 Cost of Living Allowance (COLA)
Part III - Employer Information (Previous)
16 TIN
- - - 43 Fixed Housing Allowance

17 Employer's Name 44 Others (specify)

44A
18 Registered Address 18A ZIP Code
44B
SUPPLEMENTARY
Part IVA - Summary
45 Commission
19 Gross Compensation Income from Present
Employer (Sum of Items 38 and 52) 97,500.00
46 Profit Sharing
20 Less: Total Non-Taxable/Exempt Compensation
Income from Present Employer (From Item 38) 97,500.00
47 Fees Including Director's Fees
21 Taxable Compensation Income from Present
Employer (Item 19 Less Item 20) (From Item 52) 00.00
48 Taxable 13th Month Benefits
22 Add: Taxable Compensation Income from
Previous Employer, if applicable 00.00
49 Hazard Pay
23 Gross Taxable Compensation Income
(Sum of Items 21 and 22) 00.00
50 Overtime Pay
24 Tax Due 00.00 51 Others (specify)
25 Amount of Taxes Withheld
00.00 51A
25A Present Employer

25B Previous Employer, if applicable 51B

00.00
26 Total Amount of Taxes Withheld as adjusted 52 Total Taxable Compensation Income
(Sum of Items 25A and 25B) 00.00 (Sum of Items 39 to 51B)

27 5% Tax Credit (PERA Act of 2008)

00.00
28 Total Taxes Withheld (Sum of Items 26 and 27)
00.00
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
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 informati
as contemplated under the *Data Privacy Act of 2012 (R.A. No. 10173) for legitimate and lawful purposes.

53 LANIE A. HERNANDEZ Date Signed

Present Employer/Authorized Agent Signature over Printed Name
CONFORME:
54 MARLON L. HERNANDEZ Date Signed
Employee Signature over Printed Name Amount paid, if CTC
CTC/Valid ID No. Place of
CALOOCAN CITY Date Issued
of Employee 0281928 Issue 01 09 2023 100
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
reported under BIR Form No. 1604-C which has been filed with the Bureau of (BIR Form No. 1700), since I received purely compensation income from only one employer in the Philippines
Internal Revenue. for the calendar year; that taxes have been correctly withheld by my employer (tax due equals tax withheld); that
the BIR Form No. 1604-C filed by my employer to the BIR shall constitute as my income tax return; and that BIR
Form No. 2316 shall serve the same purpose as if BIR Form No. 1700 has been filed pursuant to the provisions
55 LANIE A. HERNANDEZ 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) 56 MARLON L. HERNANDEZ
 Employee Signature over Printed Name
*NOTE: The BIR Data Privacy is in the BIR website (www.bir.gov.ph)