Annex “A”

SWORN STATEMENT

REPUBLIC OF THE PHILIPPINES

PROVINCE OF____________________

CITY/MUNICIPALITY OF____________

Dear Mam:

This is to inform your office that Mr./Ms. (Name) is the company’s authorized user of the
EACCREG for (Company Name), with TIN (000). With Business address (Address).

USERNAME :

FIRST NAME :

MIDDLE NAME :

LAST NAME :

EMAIL ADDRESS :

Very truly yours,

(Name)

Owner

Subscribe and sworn to before me, in the City/Municipality of____________________, this day
of_______, 2019 by______________with Residence Certificate No.______________issied
at______________ on______________2019.