ANNEX C

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF MISAMIS OCCIDENTAL
CITY OF OZAMIZ

I, NIMROD E. RIVERAFilipino, of legal age, designated as Proprietor ofLUMBER with business address
located at Talic, OroquietaCity do hereby certify the following:

.That incompliance with the requirements of Revenue Regulations No. , submitted herewith is the
DVD-R containing 1 BIR Form 2307 covering the period December 31, 2020.

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

.That the soft copies of the BIR Form 2307 contained in the DVD-R 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.

NIMROD E. RIVERA
Name and Signature of Authorized
Representative

SUBSCRIBE and sworn to before me, in the City of Oroq. this___dayof February,2021by
NIMROD E. RIVERA withTax Identification No. 180-586-1700-000issued at Ozamiz City, Mis. Occ.

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