ANNEX C

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF NUEVA ECIJA
CITY/MUNICIPALITY OF SAN JOSE CITY

I,_____________________________, FILIPINO, of legal age designated as __________________

of ________________________, with business address located at
________________________________, do hereby certify the following:

 That in compliance with Section 13 of Revenue Regulations No. 16-2021, submitted

herewith is the DVD-R containing the scanned copies of 2307 covering the period
06/30/2022.

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

 That the soft copies of the BIR Form 2307 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
___________, on _________ 20___.

Notary Public

Doc. No.____
Page No. ____
Book No. ____
Series of ____