ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF CAGAYAN
MUNICIPALITY OF ALCALA

I, ROLANDA SALES AVILA, Filipino, of legal age designated as Owner of _RS POULTRY AND FEEDS
SUPPLY with business address located at Baybayog, Alcala, Cagayan do herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule ANNEX A as of taxable year ending 2022.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.___.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

ROLANDA SALES AVILA

Name and signature of Authorized
Representative
TIN: ____________________

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ STA LUCIA_____________

I, __REYFEGIE L. RAMOS _ , Filipino, of legal age designated as Owner of ____KRISHA AND AJ

STORE____, with business address located at_Catayagan Sta.Lucia, Ilocos Sur do herby certify the
following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

REYFEGIE RAMOS
Name and signature of Authorized
Representative
TIN: 403-093-407

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ STA LUCIA_____________

I, ____BENITO FABRO_ _ , Filipino, of legal age designated as Owner of ____Fabro’s Eatery______,

with business address located at_Barangobong Sta.Lucia, Ilocos Sur do herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

BENITO FABRO
Name and signature of Authorized
Representative
TIN: 152-562-738

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___WILNA E. EGIDO___, Filipino, of legal age designated as Owner of ____W. E. EGIDO STORE___,
with business address located at _Busel-busel Santiago, Ilocos Sur do herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

WILNA E. EGIDO
Name and signature of Authorized
Representative
TIN: 421-511-893

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___MERPHELYN TIMON___, Filipino, of legal age designated as Owner of ____MERPHELYN TIMON

STORE___, with business address located at _San Roque Santiago, Ilocos Sur do herby certify the
following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

___MERPHELYN TIMON___
Name and signature of Authorized
Representative
TIN: 496-609-965-000

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ ___, Filipino, of legal age designated as Owner of ____ __, with
business address located at _ Santiago, Ilocos Sur do herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

___________________________
Name and signature of Authorized
Representative
TIN: 940-700-245

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ ___, Filipino, of legal age designated as Owner of ____ __, with
business address located at _ Santiago, Ilocos Sur do herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

___________________________
Name and signature of Authorized
Representative
TIN: 480-941-135

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ MARY JOY S. NAVARRETE___, Filipino, of legal age designated as Owner of __MARYMUND
STORE__ , with business address located at _ Nalasin Santiago, Ilocos Sur do herby certify the
following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

__MARY JOY S. NAVARRETE__

Name and signature of Authorized
Representative
TIN: 404-045-281

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ ROD ERICA J. PASION___, Filipino, of legal age designated as Owner of __KUKUA-MEE FOOD
SHOPPE__ , with business address located at _ Poblacion Norte Santiago, Ilocos Sur do herby
certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

__ROD ERICA J. PASION__

Name and signature of Authorized
Representative
TIN: 928-893-447-000

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ ROD ERICA J. PASION ___, Filipino, of legal age designated as Owner of __KUKUA-MEE FOOD
SHOPPE__ , with business address located at _ San Jose Candon City, Ilocos Sur do herby certify
the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

__ROD ERICA J. PASION__

Name and signature of Authorized
Representative
TIN: 928-893-447-002

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ JIANCARLO ISAURO B. ALAGAO___, Filipino, of legal age designated as Owner of _PASION
SHOPPE AND PRINT HUB__ , with business address located at _ Poblacion Norte Santiago, Ilocos
Sur do herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

__JIANCARLO ISAURO B. ALAGAO__

Name and signature of Authorized
Representative
TIN: 930-093-268-000

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ ARLON V. PASION ___, Filipino, of legal age designated as Owner of __ARLON SARI-SARI
STORE__ , with business address located at _ San Roque Santiago, Ilocos Sur do herby certify the
following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

_________________________
Name and signature of Authorized
Representative
TIN: 736-821-145-000

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ ELIZABETH M. LASTIMADO___, Filipino, of legal age designated as Owner of _ELPMIS GENERAL
MERCHANDISE__ , with business address located at _ Poblacion Norte Santiago, Ilocos Sur do
herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

__________________________
Name and signature of Authorized
Representative
TIN: 488-607-516-000

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ ___, Filipino, of legal age designated as Owner of ____ __, with
business address located at _ Santiago, Ilocos Sur do herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

___________________________
Name and signature of Authorized
Representative
TIN: 431-021-897-000

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ ___, Filipino, of legal age designated as Owner of ____ __, with
business address located at _ Santiago, Ilocos Sur do herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority 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 me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ AZELA G. EGIDO___, Filipino, of legal age designated as Owner of _AZELA SARI-SARI STORE__ ,
with business address located at _ Busel-busel Santiago, Ilocos Sur do herby certify the following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

____AZELA G. EGIDO_____
Name and signature of Authorized
Representative
TIN: 735-899-001-000

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______
 ANNEX D

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF ___ ILOCOS SUR ___________
CITY/MUNICIPALITY OF _____ SANTIAGO_____________

I, ___ DONNABEL R. GARCIA___, Filipino, of legal age designated as Owner of _LECSYLIA FASHION
SHOP__ , with business address located at _ Santiago, Ilocos Sur do herby certify the
following:

 That in compliance with section 13 of Revenue Regulations No. V-1, otherwise known as the
book keeping Regulations, submitted herewith is the DVD-R containing the summary list(s)/
Schedule(s) of inventory (stocks-in-trade, materials, supplies and other goods, etc.) and/or
other schedule _______(applicable schedules)________ as of taxable year ending ____
2020_____.

 That the contents of the DVD-Rs being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Revenue Memorandum Circular No.
_57_____.

 That the summary list(s)/ schedule(s) of inventory and/or other schedules has been made in
good faith, verified by us, and to the best of our knowledge and belief, is true and correct
pursuant to the provisions of the NIRC, as amended, and the rules and regulations and other
revenue issuances issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATIONS ARE
TRUE AND CORRECT.

____DONNABEL R. GARCIA_____
Name and signature of Authorized
Representative
TIN: 234-923-476-000

SUBSCRIBED and sworn to me, in the City/Municipality of ______________ this day of _____, 20___
by __________ with Residence Certificate No: ________________ issued at _______________, on
__________ 20____.

Doc. No. ______

Page No.______
Book No. _____
Series of ______