Annex “A.1.

1”

SWORN DECLafcszvzsdv

KNOW ALL MEN BY THESE PRESENTS:

I, (Name of Taxpayer/Claimant/Authorized Representative)

________________________________________, in my capacity as
______________________
(Position/Designation) of ______________________________________
(Business Name) with business address
at __________________________________, in relation to our claim for Value Added Tax (VAT)
refund for the period from ____________ to ____________, do hereby certify the following:

1. GENERAL PROFILE

1.1. Type of organization

__________ Single proprietorship _________ Partnership
Corporation _________ Others (specify)

1.2. Business activity (ies)

Exporter of goods _________ Manufacturing
Principal product sold ____________________ ____ Local
__________ Exporter of services _________ Trading
Type of services ____________________ ____ Local
__________ Zero-rated activities under _________ Service
Special Law (specify) _________________ ____ Local
__________ VAT exempt activities _________ Importing
___________________________________

1.3. Registration under special laws (BOI, PEZA, etc.)

Yes _________ No

If yes, specify: .

2. BOOKS OF ACCOUNTS AND ACCOUNTING RECORDS

2.1 Books maintained

General journal Sales journal
General ledger Purchase journal
Cash receipts book ___________ VAT subsidiary sales journal
Cash disbursement book ___________ VAT subsidiary purchase journal
___________ Others (specify)

2.2 Methods of recording

Manual ___________ Computerized
Permit No. ____________ Date Issued _______________

2.3 Manner of invoicing/issuance of receipts

Manual ___________ Mixed
___________ Computerized ___________ Others (specify)
Computerized Accounting
System (CAS) Permit No. _______________
Approved Serial Nos. _______________

2.4 BIR permit for:

Printer’s authority to print invoices/receipts
 ATP No. _____________ Date Issued _______________ Serial Nos. _____________________
___________ Cash register machines, and how many? ________________
___________ Computerized/Loose-leaf invoices/receipts
Permit No. ____________ Date Issued _______________

2.5 Serial numbers of sales invoices/official receipts used during the period of claim

____________________________________________________________________________________________

Spoiled/cancelled invoice numbers

____________________________________________________________________________________________

The undersigned hereby declare under the penalties of perjury that the foregoing attestations
are true and correct.

______________________________
(Signature Over Printed Name)

SUBSCRIBED AND SWORN to before me, this _____ day of ________ at

______________________, affiant with Taxpayer Identification No. _________________.

______________________________
Notary Public

Until __________________
PTR No. _______________
Issued at _______________
On ____________________

Doc. No. _____

Page No. _____
Book No. _____
Series of _____