SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ILOILO
CITY OF PASSI

I, _____________, Filipino, of legal age designated as ______________, with business address located at
______________________________do hereby certify the following:

 That in compliance with the requirements of Revenue Regulations No.____ , submitted

herewith are one (1) CD R containing ____ Scanned BIR Form 2316 covering the period
12/31/2018.
 That the contents of CD-R being submitted herewith conform to the conditions/specification
requirements set by Bureau of Internal Revenue.
 That the soft copies of the BIR Form 2316 contained the CD-R 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.

TIN

SUBCRIBED and sworn to before me, in the City/Municipality of______________________, this

day of ____2019 by _________________________ with Residence Certificate No. _______________
issued at ______________ of ________________ 2019.

Notary public

Doc. No. _________

Page No. ________

Book No. ________

Series of ________