Annex “C”

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ________________________
CITY/MUNICIPALITY OF ________________

I ________________________, ___________, of legal age designated as ___________ of

______________________________________________, with business address located at
________________________________________ do hereby certify the following:

 That in compliance with the requirements of Revenue Regulation No. _____, submitted
herewith is/are ______________ containing
____________________________________ covering the period _____________.

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

 That the soft copies of the BIR Form 2307/2316 contained in the DVD-R/s 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.

______________________________
Name and Signature of Authorized
Representative
TIN: __________________

SUBSCRIBED and sworn to before me, in the City/Municipality of ___________, this day
of ______, 20___ by ______________ with Residence Certificate No. ___________ issued at
____________, of __________ 20___.

Notary public
Doc. No. ____________
Page No. ____________
Book No. ____________
Series of _____________