TIEZA FORM NO. 353
Revised Form 1987
Tourism Infrastructure and Enterprise Zone Authority (TIEZA)
MANILA
Travel Tax Refund Application
Passenger: ________________________________ Ticket No. _____________________________
Route: ____________________________________ Date Issued ____________________________
Travel Tax Collected : P_______________________ Refundable ____________________________
Sales Report No. ____________________________ Date _________________________________
Remittance PTA O.R. No. _____________________ Date _________________________________
Reasons for Refund: ( ) Exemption |
( ) Reduced |
( ) Non-Coverage |
( ) Unused Ticket |
( ) Others |
|
_______ Non-Revenue Ticket
_______ PTA Ticket (Fare Refunded to Sponsor)
THIS IS TO CERTIFY that the above information are true and correct and that the travel tax on the above ticket has not been previously refunded.
_________________________________ |
___________________________________ |
SUBMITTED BY: |
(carrier) |
_________________________________ |
By: ___________________________________ |
(Name & Signature of Passenger) |
Name & Signature |
ADDRESS : _______________________ |
__________________________________ |
_________________________________ |
(Position) |
Tel. No. __________________________
Date prepared: _____________________
(DO NOT FILL BLANKS BELOW)
Ref. No. _____________
Revenue Department
Travel Tax and Collection Division
|
|
By |
Date |
Remarks |
1. |
Refund Application |
|
|
|
Received & Evaluated |
______________ ______________ ______________ |
2. |
Travel Tax Verified/ |
|
|
|
Indexed |
______________ ______________ ______________ |
3. |
Reviewed / Recommended |
______________ ______________ ______________ |
4. |
Voucher Prepared |
______________ ______________ ______________ |
5. |
Voucher Approved |
______________ ______________ ______________ |
6. |
Voucher Released |
|
|
|
To Accounting |
______________ ______________ ______________ |