CERTIFIED PUBLIC ACCOUNTANT

(DATE)

SECURITIES AND EXCHANGE COMMISION

Secretariat Bldg., PICC Complex,
Pasay City, Metro Manila

Gentlemen:

Relative to the increase of capital stock of ___________________ from ________________

PESOS (P________________) to _________________ (p________________). I have conducted a
special examination on the accounting records of said company to verify the validity of the
subscription payment made by the subscribers to the proposed increased in capital stock which is in
the form of CASH.

Thus, I submit the following summary of procedures performed, inquiries made and findings:

The increase in capital stock was approved by the majority of the members of the Board of Directors
of the Corporation and by an affirmative vote of the stockholders owning or representing at least two-
thirds (2/3) of outstanding capital stock during their meeting held for that purpose at its principal
office on ______________________.

The Certificate of Increase and other pertinent documents showed/revealed that out of the net increase
of __________________ PESOS (P_______________) divided into ________________ shares
with par value of _______________ Pesos (P100.00), the amount of __________________
(P __________________) has been subscribed and fully paid in CASH by the subscribers.

Upon examination of the books of accounts and supporting documents, the following were
determined and confirmed:

1. I obtained a schedule of the cash received by the company and test traced with the Cash
Receipts Book (CRB), verified against the receipts, deposit slips and other related documents.
As a result, thereof, I ascertained that the amount of ___________________ PESOS
(P_______________) was received in CASH from the following subscribers:

Name Amount O.R. No. Date

Total:

2. The above cash payments were recorded in the Cash Receipts Book (CRB) as Deposit for
Stock Subscription and that these were subsequently deposited with _______________ Bank
under Account No. ______________ on the dates of receipt.

3. I ascertained that the aforesaid cash payment was not originally disbursed to the subscribers
concerned in the form of loans and/or advances and subsequently paid back to the corporation
as their subscription payments to the capital increase nor the same was subsequently
disbursed or returned to them in the form of loan and/or advances. Therefore, the cash
 payment in the amount of ___________________ Pesos (P________________) represents
fresh and additional capital of the corporation.

4. Further I have checked the mathematical accuracy of the summary and bank reconciliation
statements, traced the receipts and disbursements and other transaction in the summary and
bank reconciliation statements to the entries in the general ledger, and compare the balances
shown in the summary and bank reconciliation statements with the balances per books and
bank statements.

In my opinion, the subscribers’ payment of ________________ PESOS (P_________) in CASH was

duly received by the corporation and properly recorded. Thus, the same constitutes fresh and
additional paid-up capital of the corporation.

This report is issued solely in accordance with the requirements of the Securities and Exchange
Commission relative to the filing of application for capital increase of ___________________.

CPA License No.

TIN No.
BOA Certificate No.
BIR AN
PTR No.
Date:
_______________ City