REPUBLIC OF THE PHILIPPINES )

LAOAG CITY ) SC.

SWORN DECLARATION

I, _____________, of legal age and in my capacity as the sole proprietor of

______________ with main office address at ________________, under oath, state that:

1. I am therefore executing this Sworn Declaration to attest to the truthfulness of

the foregoing and for whatever legal purposes this may be worth.

IN WITNESS HEREOF, I sign my name this __________ at _________________.

_______________
Affiant

SUBSCRIBED AND SWORN to before me this __________ at _________________.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2022.

REPUBLIC OF THE PHILIPPINES )

LAOAG CITY ) SC.

SWORN DECLARATION

I, JESUS NELSON S. CORPUZ, of legal age and in my capacity as the sole

proprietor of CORAL JEM PHARMACY with main office address at Brgy. 4, Nalupta,
Batac, Ilocos Norte, under oath, state that:

1. Sometime in 2018, I have initiated the request for POS permit for POS HP RP5800
model with Serial No. SGH813PNV5 which I intended to use for my Coral Jem
Pharmacy – Vintar Branch;
 2. However, I was not able to submit all the requirements within the prescribed
period hence the processing of the necessary permit never ensued;

3. Accordingly, no MIN and Permit numbers were ever reflected in my records,

and said machine was never used for business operation;

4. Neither was I notified that a permit was approved for the above-mentioned
machine;

5. I am therefore executing this Sworn Declaration to attest to the truthfulness of

the foregoing and for whatever legal purposes this may be worth.

IN WITNESS HEREOF, I sign my name this 6 July 2022 at Laoag City, Ilocos
Norte.

JESUS NELSON S. CORPUZ

Affiant

SUBSCRIBED AND SWORN to before me this 6 July 2022 at Laoag City, Ilocos
Norte.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2022.