SWORN DECLARATION
of legal age,
(Ware) {czenship)
Single/Married to permanently residing at
(Name of spouse) (neers)
With Taxpayer Identification Number (TIN)
after having been duly sworn in accordance with law hereby depose and
state :
1. That | am Employed as at
(with Salary Grade(SG)___-Step__];
2. That for the current year 2022, my net taxable compensation income will not exceed Two
Hundred Fifty Thousand Pesos (250,000.00);
3. That | duly execute this SWORN DECLARATION in compliance with the requirement
prescribed by the BIR
4, That | declare, under the penalties of perjury; that this declaration has been made in good
faith, and, to the best of my knowledge and belief, is true and correct.
IN WITNESS WHEREOF, | have hereunto set my hand this_day of 2022 at
Cavite City, Cavite, Philippines.
Signature over Printed Name
‘SUBSCRIBED AND SWORN to before me this. day of 2022 in Cavite
City, Cavite, Philippines Affiant exhibited to me his/her issued at
on
(Government Issued 1.0. and No.)
Series of 2022 NOTARY PUBLIC
Affix Documentary Stamp Tax
(hp 30.00)