Manufacturer

Production Site
Address
TIN
Assessment Number

Date Received

TOTAL

Assessment Number

:_______________________________________
:_______________________________________
: ______________________________________
:_______________________________________
:_______________________________________

Supplier/Address

Official Delivery
Invoice (ODI)
No./Import Entry
Revenue
Declaration (IERD)
No.
Beginning Balance
(i)
Carrier/Vessel

Revenue Officer on Premise

_________________________

ATTESTED BY:

I certify that all entries on this page contain true and complete details of all transactions for the period of _____________________, 2006
pursuant to existing Revenue Rules and Regulations.

_________________________

PREPARED BY:

Authorized Representative
Oil Industry-Participant

OFFICIAL REGISTER BOOK

REPUBLIKA NG PILIPINAS
KAGAWARAN NG PANANALAPI
KAWANIHAN NG RENTAS INTERNAS

Fuel Bioethanol Account

(Debit)

Actual Volume
of Fuel
Bioethanol
Received (c)

Gain/Loss on
Actual Volume
of Fuel
Bioethanol
Received
(d)
b-c

For the Month of __________, 200____

Invoice Volume

Bioethanol with Fuel Bioethanol

Bitrex
(a)
(b)

Bioethanol With
Bitrex
(e)

Total Volume
Denatured
(g)
e+f

Volume Received and Denatured

Unleaded
Gasoline
(f)

Gain/Loss
(h)
a-g

Total Available
Volume of Fuel
Bioethanol
(j)
c+g+i

Date

Amount

Excise Tax Payments

Tax
Rate

OR No.

ANNEX "A-1"