Name of Owner/Lessor___________________________________ TIN: ________________________

Address: _________________________________________________________________________________

Tenant's Profile
As of __________________________

Location of Building/Space for Commercial Lease: ______________________________________________________________

Location Name of Tenant Total Leased Monthly Start of Lease Duration / BIR Registration Profile
Floor / Unit Area Rental (mm/dd/yyyy) Period of Tax Authority to POS / CRM
No. Lease Identafication Print # for Permit #*
No. (TIN) OR's /
Invoices
LeaseUnitID CustomerName RentableSqFeetLeasePrice StartDate PeriodOfLea CustomerTIN CustomerATP CustomerPOSPer

*For taxpayers also using Point of Sdale (POS) / Cash Register Machine (CRM) in dispensing receipts
Name of Owner/Lessor____________________________________ TIN: ________________________

Address: _________________________________________________________________________________

Tenant's Profile
For the Period: ___________________________________________________

Location of Building/Space for Commercial Lease: ___________________________________________________________________

i. New Tenants
Location Name of Tenant Total Leased Monthly Rental Start of Lease Duration / BIR Registration Profile
Floor / Unit Area (mm/dd/yyyy) Period of Tax Authority to POS / CRM
No. Lease Identafication Print # for Permit #*
No. (TIN) OR's /
Invoices
LeaseUnitID CustomerName RentableSqFeet LeasePrice StartDate PeriodOfLeasCustomerTIN CustomerAT CustomerPOSPer

*For taxpayers also using Point of Sdale (POS) / Cash Register Machine (CRM) in dispensing receipts
Name of Owner/Lessor__________________________________________________ TIN: ________________________

Address: _________________________________________________________________________________

Tenant's Profile
For the Period: ___________________________________________________

Location of Building/Space for Commercial Lease: ____________________________________________________________

ii. Terminated Tenants

Location Name of Tenant Tax Identafication Total Leased Area Monthly Rental Date Lease
Floor / Unit No. Number (TIN) ended
(mm/dd/yyyy)

LeaseUnitID CustomerName CustomerTIN RentableSqFeet LeasePrice EndDate

REPUBLIC OF THE PHILIPPINES )
) S.S.

KNOW ALL MEN BY THESE PRESENTS:

I, , ______________________ OF THE ABOVE-MENTIONED

(NAME (POSITION)
CORPORATION DECLARE UNDER THE PENALTY OF PERJURY, THAT ALL MATTERS SET FORTH IN THIS LESSEE
INFORMATION STATEMENT WHICH CONSISTS OF ( ) PAGES HAVE BEEN MADE IN GOOD FAITH, DULY VERIFIED BY
ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, ARE TRUE AND CORRECT.

DONE THIS _______DAY OF ____________________, 20 _______ IN _______________________________.

__________________________
(SIGNATURE)

SUBSCRIBED AND SWORN TO BEFORE ME IN _________________________CITY/PROVINCE, PHILIPPINES ON

____________________, AFFIANT PERSONALLY APPEARED BEFORE ME AND EXHIBITED TO ME HIS/HER TAX
IDENTIFICATION NUMBER ____________________

NOTARY PUBLIC FOR ______________________ CITY/PROVINCE

DOC. NO: : Notarial Commission No. _________________________________
PAGE NO. : Commission expires on December 31, ______________________
BOOK NO. : Roll of Attorney Number __________________________________
SERIES OF : PTR No. _______________________________________________
IBP No. ________________________________________________
Office Address: _________________________________________