Republic of the Philippines)

City of Tacurong ) S.S.

x----------------------------x

AFFIDAVIT
I, Annika Y. Barba, of legal age, Filipino, (single), and resident of 4th blk Gonzales Subdivision
Brgy. Buenaflor, Tacurong city, Sultan Kudarat, after being duly sworn according to law, hereby
depose and state that:

1. I’m a freelance online English tutor.

2. My rate is Php 110.00 per hour.

3. Payments are remitted by my clients directly to my bank account.

4. Factor which influences my rate includes: my student’s attendance.

5. I am executing this affidavit in compliance with BIR Revenue Regulation No. 4-2014
dated March 03, 2014.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

________ in the City / Municipality of ______________, Philippines.

NAME

Affiant
TIN: __________________

SUBSCRIBED AND SWORN to before me this ____________________, affiant exhibited to me

his/her PTR / OTR No. ____________________ issued at ____________________ on
___________________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______.