SWORN DECLARATION

Republic of the Philippines )

City of ______ ) S.S.
x--------------------------x

I, DOUGLAS P. DUGA JR., of legal age, Filipino, resident of 321 Camacile St. Phase 3,
BLISS, Balanga City with business name of DOU-MAR GENERAL MERCHANDISE, with
business address at Villa Imperial, Lucanin, Mariveles, Bataan, do certify the following:

 In compliance with the requirements of Revenue Memorandum Circular (RMC) No.

68-2017, dated August 10, 2017, submitted herewith requirements for the application
of Permit-to-Use Loose-Leaf CASH SALES INVOICE, in lieu of the investigation
pursuant to RMC 13-82, is the Sworn Statement specifying the following;

 That, the loose-leaf form to use is the CASH SALES INVOICE only;

 That, the Company is committed to permanently bind the loose-leaf forms within
fifteen (15) days after the end of each taxable year or upon the termination of its use.

I HEREBY, UNDER THE PENALTIES OF PERJURY, THAT THE FOREGOING

ATTESTATIONS ARE TRUE AND CORRECT.

DOUGLAS P. DUGA JR.

Business Owner
TIN: 710-202-525-000

SUBSCRIBED and sworn to before me, in the City of ______________, this day of ___________,
2018 by __________________________ with Competent Identity No. _____________________ issued
at _______________ on ____________________.

Notary Public

Doc. No. ___

Page No. ___
Book No. ___
Series No. ___