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Annex "A"

CERTIFICATE OF STOCK INVENTORY


As of December 3L,2017

NAME OF TMPAYER
ASSESSMENT NO.
TAX IDENTIFICATION NUMBER
ADDRESS OF REFINERY/DEPOT/FACILITIES
DATE /TIME OF STOCKTAKING

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I declare under penalty of perjury that the aforesaid information are true and correct'

Subscribed and sworn to before me this affiant exhibiting to me his/her


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Doc. No.
Page No.
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Book No. IMEBI.IAI NEVIM,T
BUBDAU OF
Series of ITECORDS MGT. Dn'IS.-:{

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