REPUBLIC OF THE PHILIPPINES)

GUBAT, SORSOGON) S.S.

AFFIDAVIT OF NON-FILING OF INCOME TAX RETURN

(Scholarship)

I, , of legal age, Filipino,

single/married and residing at ,
after having been duly sworn in accordance with law, here
by depose and say:
1. That I am the father/mother/guardian of
who was born on at
and is applying for Senior High
School Voucher Program.

2. That my present source of income/employment is none and my annual

gross income there from is none.

3. That one of the requirements for the said application is the submission
of an Income Tax Return for the previous year/s by either parent of
which I have none.

4. That it is my wish that the Bureau of Internal Revenue with issue in my

name a Tax Exemption Certificate for use in the said scholarship
application.

5. That I executed this affidavit to attest to the truth and veracity of the
foregoing facts and not FRAUD and for whatever legal purpose it may
serve.
AFFIANT FURTHER SAYS NONE

IN WITNESS WHEREOF, I have hereunto set my hands this

at __________________________________.

Affiant

SUBSCRIBED AND SWORN to before me this at

_________________________________________________.

Doc. No.
Page No.
Book No.
Series of 2021