Republic of the Philippines)

_____________________) S.S.

AFFIDAVIT

I, xxxx, of legal age, Filipino and a resident of xxxx, do hereby depose and say that:

1. I was the President of xxxxxx from xxxxxxx

2. xxxx filed its Audited Financial Statement for Calendar Year 2020 on xxxxxx in Bureau
Internal Revenue – Revenue District Office No. 043-A, a copy of which is hereto
attached as Annex “A”;

3. The aforesaid Audited Financial Statement contains an underdeclaration of assets;

4. There is a Management Financial Statement prepared by the Independent External

Auditors and furnished to the management of xxxxx, a copy of which is hereto
attached as Annex “B”;

5. The Management Financial Statement contains the true assets of xxxxxx; and,

6. I am executing this Affidavit to attest to the truth of the foregoing statements and so
that the Bureau Internal Revenue may conduct its investigation for possible Tax
Evasion committed by xxxxxx and for any other legal purpose it may serve.

IN WITNESS WHEREOF, I have here unto affixed my signature this ________________ in

________________, Philippines.

SUBSCRIBED AND SWORN TO before me, Affiant exhibiting his ID with No.
________________ this ________________ in ________________, Philippines.

Doc No. ____;

Page No. ____;
Book No. ____;
Series of 2019