Republic of the Philippines}

City ____________________ )

AFFIDAVIT
1.) I, Jennifer G. Balbin, of legal age, FILIPINO, a resident of Brgy. Cabaroan, San
Emilio, Ilocos Sur, after having been sworn to in accordance with LAW hereby depose
and state that:
2.) Currently, the database of our POS (Point of Sales System) reached its maximum
capacity resulting in the slowdown, logging, and freezing of the system of our Sales
Machine with the following details as follows:
•
REGISTERED NAME: JENNIFER G. BALBIN
TIN: 407-536-988-001
BUSINESS NAME: HOUSEWIFE MART
BUSINESS ADDRESS: TALOGTOG, CANDON CITY, ILOCOS SUR
3.) In view of the foregoing, there is a need to Check the CPU because the SSD is not
being detected due to corruption of the operating system and hardware failure and the
hardware itself needs to be brought from the Taxpayer's main office to the POS
provider;
4.) I am executing this Affidavit to attest to the truth of the foregoing facts and
circumstances and to seek permission from the BIR for the temporary suspension of
use of the POS CPU (Point of Sales Machine) in compliance with the BIR Rules and
Regulations and for whatever legal purpose it may serve best.
IN WITNESS WHEREOF, I hereby signed this affidavit this __ day of ________ at
Candon City, PHILIPPINES.

JENNIFER G. BALBIN
Affiant

ID NO: ____________________