Republic of the Philippines)

City of Pasig )s.s.

AFFIDAVIT OF NON-FILING OF INCOME TAX RETURN (Scholarship)

I, (name of parent or guardian), of legal age, married/single, Filipino

and with residence address at (location), after having been duly sworn to in
accordance with law hereby depose and say, that;
1. I am the father/mother/guardian of (name of child) and is applying
for scholarship grant.
2. My present source of income /employment is none and my annual
gross Income therefrom is none.
3. 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. 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. 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

I have here unto I set my hands this (day) of (month) 2021.

(name of affiant)
Affiant

SUBSCRIBED AND SWORN to before me this day of September 2021.

Doc No. ____

Page No. ____
Book No. ____
Series of 2021