AFFIDAVIT - DECLARATION
OF CURRENT YEAR’S GROSS INCOME
Republic of the Philippines )
Province of )
City/Municipality of )
1 also known as of legal age.
single/manied, residing at alter being swom in
accordance with law, depose and say that:
1. I receive professional / talent / service fees as
(please check box/es)
J / Practice of Profession / / Management & Technical Consultants
Professional Entertainment Bookkeeping agents and agencies
/ / Professional Athlete / / Other recipients of talent fees
/ (Director / Director who is not employee of the
company
/ | Others: Specify / Judicial person in the practice of
profession
2. As such, I have received a gross income of P for the
current year as of.
3. I am executing the Affidavit-Declaration as a requizement of Revenue
Regulations No, 30-2003 of the Bureau of Internal Revenue in the determination,
of the applicable creditable withholding tax rate (10% or 15%) to be imposed by
withholding agent.
IN WITNESS WHEREOF, I ha
in the Municipality
hereunto set my hand this day of
province of
Philippines.
Affiant — Declarant
TIN:
SUBSCRIBED AND SWORN to before me, in this day
of, with Community Cettificate No. issued at
on 20,
Doe. No,
Page No,
Book No.
Series of 20