Annex “C”
SWORN DECLARATION
REPUBLIC OF THE PHILIPPINES
PROVINCE OF ____________________________
CITY/MUNICIPALITY OF ____________________
I, (Name of Authorize Representative), (Nationality), of legal age designated as (Position) of Registered
Name of the Company Corporation), with business address located at
__________________________________ do hereby the following:
That in compliance with the requirements of Revenue Regulations No._____, submitted
herewith is/are (Number of DVD-R/s) containing (Number of Scanned BIR Form
2307/2316) covering the period mm/dd/yyy
That the contents of the DVD-Rs being submitted herewith conform to the
conditions/specification requirements set by the Bureau of Internal Revenue
That the soft copies of the BIR Form 2307/2316 contained in the DVD-R/s being submitted
herewith are the complete and exact copies of the original 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 Residences Certificate No. ______________issued at
_____________, of _____________ 20___.
Notary Public
Doc No. _____________
Page No. ____________
Book No. ____________
Series of ____________