SWORN STATEMENT

I, LEONARDO REY D. VASQUEZ, Filipino, of legal age designated as General Manager of

ZAMBOANGA CITY WATER DISTRICT, with business address at Pilar Street, Zone IV, Zamboanga
City, do hereby certify the following:

1. That, ZAMBOANGA CITY WATER DISTRICT with business address at Pilar Street,
Zone IV, Zamboanga City is a Government-owned and controlled corporation, formed and
created pursuant to Title II, Chapter II, Section 6 of Presidential Decree No. 198, by
Resolution No. 77 adopted by the City Council od Zamboanga on March 4, 1974;

2. That in lieu of the investigation pursuant to RMC No. 13-82, we undertake to do/comply the
following:
a. That we identified the Computerized Water Official Receipts (continuous form) to be
used with Serial No. 2130001A to 2850000A, Pre-Printed Water Bills with Serial No.
5325000 to 7305000; and
b. That we commit to permanently bind the loose-leaf forms within fifteen (15) days
after the end of each taxable year or upon the termination of its use.

3. That we request for authority to use loose-leaf forms for computerized water official receipts
(continuous form) & water bills form in consideration of the above circumstances.

I declare, under the penalties of perjury, that the foregoing attestations are true and correct to the
best of my knowledge and belief.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of ____________, 20___ at
___________, Philippines

LEONARDO REY D. VASQUEZ

Taxpayer/Authorized Representative

Position: GENERAL MANAGER

TIN: 000 584 763 000
Address: Pilar Street, Zone IV,
Zamboanga City

SUBSCRIBED AND SWORN to before me this _____ day of ____________, 20___ in

_______________________________. Applicant exhibited to me his/her
___________________________issued at _______________________ on _________________________.

Doc. No.: __________

Page No.: __________
Book No.: __________
Series of ___________