Republic Of The Philippines - Sworn Statement
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1Annex “A”
SWORN STATEMENT
REPUBLIC OF THE PHILIPPINES
PROVINCE OF________________________
CITY/MUNICIPALITY OF ______________
I, (Name of Authorized Representative), (Nationality), of legal age designated as
(Position) of (Registered Name of Company/Corporation), with business address
located at _____________________________________, do hereby certify the following:
•
THAT the company is engaged in, (line of business) and existing under
(business name), with TIN__________________.
•
THAT the (Type of Machine/Name of Software) conform to the
conditions/specification requirements set by the Bureau of Internal
Revenue;
•
THAT the (Type of Machine/Name of Software) has the following essential
features;
•
•
•
(Attach additional sheet if necessary)
•
THAT in the event that the foregoing be discovered to be in violation of
existing rules and regulations, I hereby undertake to face any legal
sanctions and pay corresponding penalties thereof as provided for under
the National Internal Revenue Code of 1997;
I
HEREBY
DECLARE
UNDER
PENALTIES
OF
PERJURY
THAT
THE
FOREGOING ATTESTATIONS ARE TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE.
Name and Signature of
Affiant/Authorized Representative
TIN: ___________________________
SUBSCRIBED
and
sworn
to
before
me,
in
the
City/Municipality
of
____________________________, this day of __________, 20___ by ____________________
with Residence Certificate No. _______ issued at _____________ on, ______________
20___.
Notary Public
Doc. No.
_______
Page No.
_______
Book No.
_______
Series of
_______
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