REPUBLIC OF THE PHILIPPINES)

CANDABA, PAMPANGA )S.S.

AFFIDAVIT OF NON-FILING OF INCOME TAX RETURN

We, ______________________________ and ___________________________________, both of legal ages,

Filipino Citizens, and residents of Sitio 5 Vizal Sto. Cristo, Candaba, Pampanga, after having been duly sworn to in
accordance with law, hereby depose and state:

1. That we are the parents of _____________________________.

2. That ________________________________ is currently enrolled as First Year college student at
________________________________.
3. That our said son/daughter is applying in a Scholarship Program under the Ched Student Financial
Assistance Program.
4. That one of the requirements is a proof of the Bureau of Internal Revenue (BIR) validated Income Tax
Return (ITR) of parents/guardian.
5. That we did not file our ITR at the BIR because our income does not exceed Php 60,000.00, our job being
__________ and ____________, respectively.
6. That we are executing this affidavit to attest to the truth of all the above facts and statements for all legal
intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto signed this document this ___ day of ______, 2022 in
Barangay Vizal Sto. Cristo, Candaba, Pampanga.

____________________________ ________________________________
Affiant Affiant

SUBSCRIBED AND SWORN to before me this _____ day of ______, 2022 in

_______________________________. Affiant exhibited to me their respective community tax certificates appearing
below their respective signatures.

NOTARY PUBLIC
Doc. No.: ____________________
Page No.: ____________________
Book No.: ___________________
Series of 2022