REPUBLIC OF THE PHILIPPINES

PROVINCE OF SORSOGON
MUNICIPALITY OF GUBAT

AFFIDAVIT OF NON-FILING OF INCOME TAX RETURN

I__________________________ ______ of legal age Filipino citizens, and resident of

_________________________ after having been duly sworn to in accordance with law, hereby
depose and state:

1. That I am ___________________ of ___________________

2. That I am unemployed since year_________ up tp present;

3. That my _________is applying to avail scholarship and for which he is being required to
present the latest income Tax Return (ITR) of his family

4. That I execute this affidavit to attest to the truth of the foregoing facts and for the
purpose of applying for the SCHOLARSHIP of my ________

In witness whereof, I have hereunto set my hand this ________day, 20_ in the Province of
Sorsogon,Philippines.

SUBSCRIBED AND SWORN to before me this _________day of ____ 2020 at Gubat Sorsogon,
Philippines. ID______________

____________________
Affiant

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