REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC ) S.C.

SWORN STATEMENT

I, JAYSON A. GONGORA, of legal age, born in the Victoria, Tarlac, Philippines,

and currently residing at Unit A-5-1 Grd Flr Blk A SPG 58 KG Serusop Brunei,
after having been duly sworn in accordance with law, do hereby depose and
state that:

1. I am a non-resident Filipino citizen/ Overseas Filipino Worker (OFW) with

proof of permission to work abroad as evidenced by my Working Visa,
with Reference number E28908;
2. My source of income is from outside the Philippines which is Fuel’ D
Restaurant and Catering and located at Ground Floor, Unit A4, Setia
Kenanganz Banoar Seri Begawan BE1518 and I do not derive any income
from Philippine sources. As such, I am not required to file an Individual
Income Tax Return (ITR) in the Philippines.
3. I further state that on the same day of execution of this SWORN
STATEMENT, I did legally and properly submit my Employment Contract
dated June 23, 2022 and all other supporting documents.
4. I am executing this Sworn Statement to attest to the truth of all the
foregoing statements and for whatever legal purposes it may serve.

IN WITNESS THEREOF, I have hereunto set my hand this 25 th day of July 2022
in Victoria, Tarlac, Philippines.

JAYSON A. GONGORA
Affiant

SUBSCRIBED AND SWORN to before me, this 25 th day July 2022 in the
Province of Tarlac by the affiant, who exhibited to me his Competent Evidence
of Identity.

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REPUBLIC OF THE PHILIPPINES)
PROVINCE OF TARLAC ) S.C.

SWORN STATEMENT

I, MARIA MERCEDES F. GONGORA, of legal age, born in the Salapungan, Tarlac

City, Philippines, and currently residing at Unit A-5-1 Grd Flr Blk A SPG 58 KG
Serusop Brunei, after having been duly sworn in accordance with law, do hereby
depose and state that:

1. I am a non-resident Filipino citizen/ Overseas Filipino Worker (OFW) with

proof of permission to work abroad as evidenced by my Working Visa,
with Reference number E29173;
2. My source of income is from outside the Philippines which is Algel Hair
and Beauty Salon and located at Unit A-5-1 Grd Flr Blk A SPG 58 KG
Serusop Brunei and I do not derive any income from Philippine sources.
As such, I am not required to file an Individual Income Tax Return (ITR)
in the Philippines.
3. I further state that on the same day of execution of this SWORN
STATEMENT, I did legally and properly submit my Employment Contract
dated June 24, 2022 and all other supporting documents.
4. I am executing this Sworn Statement to attest to the truth of all the
foregoing statements and for whatever legal purposes it may serve.

IN WITNESS THEREOF, I have hereunto set my hand this 25 th day of July 2022
in Victoria, Tarlac, Philippines.

MARIA MERCEDES F. GONGORA

Affiant

SUBSCRIBED AND SWORN to before me, this 25 th day July 2022 in the
Province of Tarlac by the affiant, who exhibited to me her Competent Evidence
of Identity.

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Page No.
Book No.
Series of 2022