Annex "C"
SWORN DECLARATION
REPUBLIC OF THE PHITIPP]NES
PROV]NCE OF
CIfY/MU NICIPALITY OF
(Postior)
l, lNome af Authorized Representotive), \Notionolitv), of legal age desiSnated as of
(Reoistered Nome of componv/Cotporotion), with business address located at
do herebv certify the follow ng:
- That in compliance with the reqLrlrements of Revenue Regulations No.-, submltted
herewith is/are (Nurnber of DVD R/s) containing lllllbei--ql j!3M!L--ElB_lEPlE
2307/2316) covering the period mm/dd/wv.
z That the contents of the DVD-Rs being submitted herewith conform to the
conditions/specification requirements set by the Bureau of lnternal Revenue.
- That the soft copies of the BIR Form 2307/2316 contained in the DVD-R/S being submitted
herewith are the complete and exact copies of the original thereof.
I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING
ATTESTATIONS ARE TRUE AND CORRECT.
Name and signature of Authorized
Representative
TIN:
and sworn to before me, in the City/Municipallty of this day
of _, SUBSCRIBED
20_ by with Residence Certificate No. issLred at
2a
al
Notary public BURIAU 0l'
RECORDS
lNlliliN/J RrlE)arn
Doc. No. MGT. NIVISION
Pag-. No.
Book No. {t} r, r 206
Serles of 0t ? a lnt
R.ECEtrVED
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