REPUBLIC OF THE PHILIPPINES)

QUEZON CITY, METRO MANILA) S.S.

AFFIDAVIT OF NON-FILING OF INCOME TAX RETURN

(Scholarship)

I, _________________________________________, of legal age, Filipino,

single/married and residing at __________________________________________________,
after having been duly sworn in accordance with law, here
by depose and say:
1. That I am the father/mother/guardian of ____________________________________
who was born on _____________________ at _______________________________________
and is applying for a scholarship grant.

2. That my present source of income/employment is none and my annual

gross income therefrom is none.

3. That one of the requirements for the said application is the submission of
an Income Tax Return for the previous year/s by either parent of which I
have none.

4. That it is my wish that the Bureau of Internal Revenue with issue in my

name a Tax Exemption Certificate for use in the said scholarship
application.

5. That I executed this affidavit to attest to the truth and veracity of the
foregoing facts and not FRAUD and for whatever legal purpose it may
serve.
AFFIANT FURTHER SAYS NONE

IN WITNESS WHEREOF, I have hereunto set my hands this _______________

at Quezon City, Metro Manila.

________________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________________at Quezon

City, Metro Manila.

Doc. No. ______

Page No. ______
Book No. ______
Series of 2019