REPUBLIC OF THE PHILIPPINES)

DONE: IN THE CITY OF _________) S.S.

AFFIDAVIT OF ANNUAL INCOME

I, _____________________, of legal age, single, Filipino Citizen and a
resident of ________________________________ after having been duly sworn to in
accordance with law hereby deposes and states that:

1. I am applying for BIR EXEMPTION CERTIFICATE for the scholarship

program of my son ____________________ with the Bureau of Internal
Revenue (BIR);

2. I am a plain Housewife and although engage in some livelihood, my

income is just enough for our daily needs and my annual income
does not exceed SIXTY THOUSAND PESOS (P60,000.00);

3. I am executing this affidavit to attest to the veracity of my foregoing

statements and to support the application of son
__________________________ for Scholarship Program and for all legal
intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of

January, 2019 at ____________________, Philippines.

___________________________
Affiant
PRC Lic. No. ________________
Valid Until: _____________

SUBSCRIBED AND SWORN to before me this 26 th day of January, 2019

at Baguio City, Philippines. Affiant personally appeared and to be the same
person who executed this instrument voluntarily.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2019.