Annex “C”

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

CITY OF MANILA

I, JOSEPH HUNG ,Filipino of legal age designated as President of

CONCEPT SPECIALIST, INC with business address at 77 Scout Fuentebella St., Laging
Handa Quezon City, do hereby certify the following:

That in compliance with the requirements of Revenue Memorandum Circular No. 36-
2015 dated June 8 2015, submitted herewith are the hard and soft of the Inventory List of
all Cash Register Machines (CRMs)/Point of Sales (POS) Machines/ Special Purpose
Machines (SPMs) an Other Similar Machines Generating Sales Invoices/Receipts as
of June 30, 2015, referred to herein as “Annex A”

That the contents of the hard copies of the Inventory List consisting of 1 pages in
excel format, and soft copies as contained in 1 Digital Versatile Disk-Recordable (DVD-
R) being submitted herewith conforms to the conditions/specifications requirements set
by the Bureau of Internal Revenue, and are the complete and accurate list of all
CRM/POS/SPM and other Similar Machines Generating Sales Invoices/Receipts
physically located within the business premises as of June 30, 2015.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE

FOREGOING ATTESTATIONS ARE TRUE AND CORRECT.

JOSEPH HUNG
President

TIN: 193-612-922-000

SUBSCRIBED and sworn to before me, in the City/Municipality of ______________,

this day of ___________________, 2015 by _____________________ with Community Tax
Certificate no.________ issued at, _________, on ___________.

Notary Public
Doc. No.________
Page No.________
Book No.________
Series of __2015__