REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE
OFFICE OF THE REVENUE DISTRICT OFFICER
Revenue District No. 20
City of Balanga, Bataan

C E R T I F I C A T I O N

This is to certify that _____________________________, residents of

Barangay _______________, Dinalupihan, Bataan, have no records of Income Tax
Returns filed for Taxable Year 2020.

Based on the Sworn Affidavit and Certification issued by the Office of the
Punong Barangay of Barangay ___________________________, Dinalupihan,
Bataan, the said individuals have no permanent source of income; hence, they are
classified as indigent.

This certification is issued based on the documents submitted and facts

represented by ______________ ____________ for the sole purpose of availing the
Special Program for Employment of Students (SPES) of their son/daughter, ___-
_______ ________________________________. Any deviation from the said facts
and purpose will render this Certification invalid.

Given this ______ day of July 2021 at municipality of Dinalupihan, Bataan.

ATTY. AGAKHAN M. GURO

Revenue District Officer

By:

SARAH MAE M. DE LEON

Revenue Officer

Documentary Stamps
here
NOTE: This certificate is considered void if:
• Without attached BIR Form 51 (Official Receipt)
• Without affixed Documentary Stamps Tax of ₱30.00
*Subject to validation with our database – Integrated Tax System