ANNEX D
SWORN DECLARATION
REPUBLIC OF THE PHILIPPINES
PROVINCE OF ILOCOS SUR
CITY/MUNICIPALITY OF VIGAN
I, JHON MARK M. ACELADOR, Filipino, of legal age, designated as OWNER of
ACELADOR SARI-SARI STORE, with business address located at Barangay Labut Norte, Santa,
Ilocos Sur, 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 inventory lists as of taxable year ending December 31,
2024.
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. 57, dated September 2015.
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.
JHON MARK M. ACELADOR
Proprietor
TIN No. 492-396-761-00000
SUBSCRIBED and sworn to before me, in the City/Municipality of VIGAN CITY, this day
of ______________________, 2024 with Residence Certificate No. _____________________
issued at _________________________, on _____________________ 2024.
Notary Public
Doc. No. ____
Page No. ____
Book No. ____
Series of: ____
