AFFIDAVIT OF NON-FILING OF INCOME TAX

I, RAFAEL P. POLICARPIO, married to, Rose Marie P. Policarpio, of legal age, Filipino, with postal
address at 19 Peach Road, Orchard Residential Estates, Salitran, Dasmarinas, Cavite, after having
been sworn to in accordance with law, hereby depose and say:

That I hereby attest to the fact that I retired from my work employment in the year 2009;

That I executed this affidavit to attest to the fact that I did not file an Income Tax Return since my
retirement .

This Affidavit is being executed for all legal intents it may serve.

IN WITNESS WHEREOF, we hereunto affix our signature this day of ___________________ at

________________________.

RAFAEL P. POLICARPIO
Affiant

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

_____________________ )S.S.

BEFORE ME, personally appeared:

NAME GOVERNMENT ISSUED ID

RAFAEL P. POLICARPIO Philippine Drivers License Number N-10-78-038495

Known to me and to me known to be the same persons who executed the foregoing instrument and
acknowledged to me the same is their free and voluntary act and deed;

WITNESS MY HAND AND SEAL this day of _______________________ in__________________________.

Notary Public

Doc. No.: _____

Page No.: _____
Book No.: _____
Series of 2019