Annex “A.1.

1”

TAXPAYER’S ATTESTATIONS

KNOW ALL MEN BY THESE PRESENTS:

(Name of Taxpayer/Claimant/Authorized Representative) in my capacity as ______________________

I, ________________________________________, (Position/Designation)

(Business Name)
of ______________________________________ with business address at
__________________________________, in relation to our claim for Value-Added Tax (VAT) refund
for the period from ____________ to ____________, do hereby attest the following:

1. GENERAL PROFILE

1.1. Type of organization

__________ Single proprietorship _________ Partnership
Corporation _________ Others (specify)

1.2. Business activity (ies)

Exporter of goods _________ Manufacturing
Principal product sold ____________________ ____ Local
__________ Exporter of services _________ Trading
Type of services ____________________ ____ Local
__________ Zero-rated activities under _________ Service
Special Law (specify) _________________ ____ Local
__________ VAT exempt activities _________ Importing
___________________________________

1.3. Registration under special laws (BOI, PEZA, etc.)

Yes _________ No

If yes, specify: .

2. BOOKS OF ACCOUNTS AND ACCOUNTING RECORDS

2.1 Books maintained

General journal Sales journal
General ledger Purchase journal
Cash receipts book ___________ VAT subsidiary sales journal
Cash disbursement book ___________ VAT subsidiary purchase journal
___________ Others (specify)

2.2 Methods of recording

Manual ___________ Computerized
Permit No. ____________ Date Issued _______________

2.3 Manner of invoicing/issuance of receipts

Manual ___________ Mixed
___________ Computerized ___________ Others (specify)
Computerized Accounting
System (CAS) Permit No. _______________
Approved Serial Nos. _______________

2.4 BIR permit for:

Printer’s authority to print invoices/receipts
ATP No. _____________ Date Issued _______________ Serial Nos. _____________________
___________ Cash register machines, and how many? ________________
___________ Computerized/Loose-leaf invoices/receipts
Permit No. ____________ Date Issued _______________

2.5 Serial numbers of sales invoices (SI)/official receipts (OR) used during the period of claim

____________________________________________________________________________________________

Spoiled/cancelled SI/OR numbers

____________________________________________________________________________________________
 2.6 Letter of Authority, if any, issued for the audit of VAT or all internal tax liabilities for the same taxable year/period
covered by the claim:

Letter of Authority No. : ____________________

Issuing BIR Office : ____________________
Tax Type : ____________________
Taxable Year/Period : ____________________

3. BREAKDOWN OF SALES

ZERO-RATED SALES
Direct Export P
Indirect Export
SALES SUBJECT TO 12% VAT
EXEMPT SALES
TOTAL SALES FOR THE PERIOD P

4. COMPLETENESS AND AUTHENTICITY OF DOCUMENTS OF

a. The documents submitted for purposes of processing our herein claim for VAT refund and these are the only
documents that will be presented to support our claim;
b. The SIs and Airway Bill/Final Bill of Lading for sale of goods, or ORs with Billing Statements/ORs with Statements
of Account and/or Service Contracts/ORs with Job Order or any equivalent document for sale of services;
c. The SIs for purchase of goods or ORs with Billing Statements or Statements of Account, or any equivalent document,
for purchase of services; and
d. The VAT Payment Certification from the Bureau of Customs, Import Entry and Internal Revenue Declarations and/or
Single Administrative Document, Statement of Settlement of Duties and Taxes and commercial invoices. (For claims
with input VAT on importation/s)

5. ENDING INVENTORY

The ending inventory as of close of the period being claimed has been used directly/indirectly in the products
exported, if applicable.

6. OTHER ATTESTATION/S:

a. That the company did not file any and/or will not file any similar claim from another BIR office and/or the DOF-OSS
(for claims with importation).
b. That the books of accounts and accounting records are available for verification by authorized BIR Revenue Officer(s)
upon request and that failure on our part to present said books and records is a ground for denial of our refund.

The undersigned hereby declare under the penalties of perjury that the foregoing attestations are
true and correct.

______________________________
(Signature Over Printed Name)

SUBSCRIBED AND SWORN to before me, this ____ day of ___________, 20__ at
________________________, affiant exhibited to me his/her (competent evidence of identity – e.g.
government issued ID) issued on ________________ at ______________________ indicated below
his/her name.

______________________________
Notary Public

Until __________________
PTR No. _______________
Issued at _______________
On ____________________

Doc. No. _____

Page No. _____

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Book No. _____
Series of _____