OFFICIAL RECEIPT
Republic of the Philippines
Accountable Form No. 51
Revised January,1992 ORIGINAL
DATE
NO. A
AGENCY FUND
PAYOR
ACCOUNT
NATURE OF COLLECTION AMOUNT
CODE
TOTAL ₱
AMOUNT IN WORDS
Drawee Number
Date
Cash
Bank
Check
Money Order
Received the amount stated above
______________________________
COLLECTING OFFICER
Note: Write the number and date of this receipt at the back of check or money order
received.
In settlement of the following:
Invoice No. Amount BICOL
INTERCITY TRANSPORT COOPERATIVE (BITCOOP)
Regidor St., Maroroy, Daraga, Albay 4501
Non-VAT Reg. TIN: 739-794-600-000
Total Sales OFFICIAL
RECEIPT
Less: SC/PWD Discount
Date: _____________
Total Due Received
from _____________________________________________
Less: Withholding Tax
with TIN
_____________________________________________________
Payment Due
and address at
________________________________________________
engaged in the
business style of __________________________________
the sum of
___________________________________________________
Form of Payment
_______________________________________________________ pesos
Check Cash (P___________)
in partial/full payment of account ___________________
Check No Date
Bank Branch
____________________________________________________________
100 Bklts. (50x3) SN: 3,751 – 8,750
Sr.Citizen TIN:
BIR Authority to Print No. 1AU0002292740
By: _____________________________
OSCA/PWDIDNo.:
Signature: Cashier/Authorized Representative
Date Issued: 02-13-2021
Valid Until: 02-13-2026
Brgy. 16 Benjamin Imperial St,
Legazpi City, Albay
TIN: 175-847-906-000
Printer’s Accreditation No. 057MP20190000000021
“ This document is not valid for claiming input tax.”
Date Issued: 07-18-2019 THIS OFFICIAL
RECEIPT SHALL BE VALID FOR FIVE(5) YEARS FROM THE DATE OF ATP