Annex D

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ANNEX D

SWORN DECLARATION
REPUBLIC OF THE PHILIPPINES
PROVINCE OF ______________________
CITY/MUNICIPALITY OF ______________
I, (Name of Authorized Representative), (Nationality), of legal age designated
as (Position) of (Registered Name of Company/Corporation), with business
address located at ______________________________ do hereby certify the
following:

That in compliance with Section 13 of Revenue Regulations No. V-1,


otherwise known as the Bookkeeping 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
schedules _____(applicable schedules)________ as of taxable year
ending __________.

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.
_____________________________
Name and Signature of
Authorized
Representative
TIN: ________________________
SUBSCRIBED and sworn to before me, in the City/Municipality of ______,
this day of ____, 20___ by ________________ with Residence Certificate No.
__________ issued at ___________, on _________ 20___.
Notary Public
Doc. No.____
Page No. ____

Book No. ____


Series of ____

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