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CERTIFIED GROSS SALES / GROSS RECEIPTS

Taxable Year __________


Period Covered

January Php ______________________


February Php ______________________
March Php ______________________
April Php ______________________
May Php ______________________
June Php ______________________
July Php ______________________
August Php ______________________
September Php ______________________
October Php ______________________
November Php ______________________
December Php ______________________
Total ______________________

Certified True & Correct

__________________________
Owner / Proprietor
(Signature over Printed Name)

Subscribed and sworn to before me this _______ day of __________________________


20_____, affiant(s) exhibited to me his / her / their CTC Nos. _________________________ and
________________, issued at ______________________ on __________________.

NOTARY PUBLIC

Doc. No. ___________:


Page No. ___________:
Book No. ___________:
Series of 20 _________:

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