Annex 68-C

ORGANIZATIONS
NON-PROFIT
SCHEDULES FOR NON-STOCK,
NSPO Form-1

swORN STATEMENT

66MMA 6. coNNNO
CALITO ONT NO and
corp ope
We, BxCEEOnJG_621E OPEAURH
President and Treasurer, respectively, of OtoL hereby
usONU_46ENA VISTA
with address at
depose and state that:
information
the Revised SRC Rule 68,
we are stating the following
In compliance with to wit:
that related to the preceding
fiscal year 2022
Check if
Audited Financial Statements
Documents/ Schedules to the NSPOForms Applicable
asof
1.Affidavit of Wilingness toorbe Audited by the Commission NSPO Fom-2
Income or Sources of Funds NSPOForm-3
2. Schedule of Receipts
Ofher Than Contribufions and Donations NSPO Fom-4
3. Schedule of Contributions and Donations NSPO Fom-5
4. Schedule of Application of Funds
5. Certificate of Existence of Program/Activity (COEP)
institution or
6. COEP issued by Heads/Officers of private
actual beneficiaries/recipients of the program/activity
issued by the
shall be allowed in lieu of COEP
govemment offices/entities
attached documents/schedules
We hereby certify that this Swom Statement with duly
is executed to attest to the truth of the foregoing and for whatever legal purgogeitmay serve.

have hereunto affixed our signature this day of

In witness thereof, we

at Philippines.

cARLITD CBWTIWO 6EMMA . ctTIN

Treasurer
President

sptscloedd sworn to before me, a Notary Public for and in

evidencee
City, on, affiants personally, exhibiting their respective competent
issued at issued on
of ldenification Card

NOTARY PUBLIC

Doc. No. MTY. ADAM REION L. JALA

Page No. Notary Public for Tags
NCS. No. 20
an City, Bohol

Book No. Cormm. Expires on ec. 31, 2023

Series of 3/F Pamugas Bullding, J.A. Clarin Street
Dampas District, Tagbilaran Ciy, Boho
Roli No. 53192, 18P 0%98, TIN 232-794-746
MCLE COMPL VI O0O6672, valia until 4-14 22 (Ext. 1 year)
PTR No. 1103266, 12-21-22 for 2023
58
 NSPO Form-2

Page I of1

REPUBLIC OF THE PHILIPPINES)

TAS DILT Cfy )S.S.

AFFIDAVIT OF WILLINGNESS TO BE AUDITED BY THE COMMISSION

66MMA 6. cENTmNO
of legal age, Filipind and resident of
PoMAA0 SA6AYAN Po fDL after having been swom to in
accordance with law hereby depose and state:

I am the Treasurer/Chief Finance Officer of EXCEEUDG 62ACE oF 60 Cunc4 ColennrC

stock non-profit organization registered with the Securities and Exchange Commission.

That I, as authorized by the Board of Directors of the

to be audited by the Commission
corporation, hereby manifest its willingness
upon its Order and Authority for the purpose of determining
compliance of the corporation with existing laws and regulations.
That this affidavit is executed to attest to the truth of the
purpose and intent it may serve.
foregoing and for whatever legal
08 MAR 2023
In witness whereof, I hereby sign this affidavit this day of 20 af

6FMMA cGUTINO
Affiant
(Signature over Printed Name)

O8 MAR 2023
SUBSCRIBED AND SWORN to before me this affiant exhibiting to me his
issued on as competent
evidence of identity.

Doc. No.
Page No. 2
Book No. ATTY. ADAM RESONL. JALA
Series of 20 V Notary Public for Taran City, Bohol
NCS. No. b22-23
Comm. Explres on Dec. 31, 2023
3/F Pamugas Bullding, I.. Carin Street
Dampas District, lagollaran itY, 80nol
Roll No. 53192, 18P SE98, TIN 232-794-746
MCLE COMPL VI 0006572, valid until
-1o22 (Ext. year)
1
PTR No. 1103265, 12-21-22 for 2023

59
 NSPO Form-3

OR SOURCES OF FUNDS
sCHEDULE OF RECEIPTS OR INCOME
DONATIONS
oTHER THAN CONTRIBUTIONS AND

SEC Registration No.

Name of Foundation/Organization
EXEEO/US 6ACG OF GoD CMMRcH Cnf CW2014633 03
For the Year Ended
2202

Receipts orincome or Sources of Funds

(d)
Amount
(indicate by
footnote if other
than Philippine
curencY, then (e)
(c) translate in this Date Received/
(a) (b)
No. Description ofIncome Source column) Period Covered
P
0NATIO eMenn
2 P

3 P

5 P

6 P

8 P

Others (aggregate of all P

10 sources of income which
are individualy below
PI00,000)
(Use separate sheet if nece ory)

60