Annex 68-C

SCHEDULES FOR NON-STOCK, NON-PROFIT ORGANIZATION

NSPO Form-1
SWORN STATEMENT
We, _________ and ___________, President and Treasurer, respectively, of
________________ with address at _______________________ hereby depose and state that:
In compliance with the Revised SRC Rule 68, we are stating the following information that
related to the preceding fiscal year _____, to wit:

Documents/ Schedule to the Audited Financial Statement as Check if

of 2020 NSPO Forms Applicable
1. Affidavit of Willingness to be Audited by the NSPO Forms-2 ✓
Commission
2. Schedule of Receipts or Income or Source of Funds NSPO Forms-3 ✓
Other Than Contributions and Donations
3. Schedule of Contributions and Donations NSPO Forms-4 n/a
4. Schedule of Application of Funds NSPO Forms-5 n/a
5. Certificate of Existent of Program/ Activity (COEP) n/a
6. COEP issued by Heads/Officers of private institutions or n/a
actual beneficiaries/recipient of the program/activity
shall be allowed in lieu of COEP issued by the
government offices/entities

We hereby certify that this Sworn Statement with duly attached documents/schedules is
executed to attest to the truth of the foregoing and for whatever legal purposes it may serve.
In witness thereof, we have hereunto affixed our signature this ______ day of __________, at
__________________, Philippines.

________________ _______________
President Treasurer

Subscribed and sworn to before me, a Notary Public for and in _____________________
City, on affiants personally, exhibiting their respective competent evidence of Identification Card
___________________________ issued at ___________________________________ issued on
_________________.

NOTARY PUBLIC
Doc No.__________
Page No. _________
Book No._________
Series of_________