Annex “C”

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

_____________________
CITY OF MUNTINLUPA

I, Vicente Bienvenido B. Gutierrez, Filipino, of legal age are designated as President of

BAHAY SA PINAS USA INC. with business address located at 9F Filinvest One Bldg.
Northgate Cyberzone, Alabang, Muntinlupa City do hereby certify the following:

1.That in compliance with the requirements of Revenue Regulations 2-2015., submitted

herewith is one (1) DVD containing five (5) BIR Form 2316 covering the period January 1 to
December 31, 2019.

2. That the contents of the DVD-Rs being submitted herewith conform to the
conditions/specification requirements set by the Bureau of Internal Revenue.

3. That the softcopies of the BIR Form 2316 contained in the DVD-R being submitted
herewith are the complete and exact copies of the original thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE

FOREGOING ATTESTATIONS ARE TRUE AND CORRECT.

VICENTE BIENVENIDO B. GUTIERREZ

TIN: ____________________

SUBSCRIBED AND sworn to before me, in the City of _____________ this day of
________________, 2020 by _____________________ with residence Certificate No.
_____________issued at _____________________ , of ____________________ 2020.

Notary Public

Doc No.
Page No.
Book No.
Series of 2020