Republic of the Philippines}

Quezon City, Metro Manila} S.S.

AFFIDAVIT OF NO INCOME &

NON–FILING OF INCOME TAX RETURNS

I, ___________________________, Filipino, of legal age, single/married, with

residence address at ____________________________________________________
_____________________________________________, after having been duly sworn
in accordance with law, hereby depose and say:

1. That I have not been employed since ________________ and I have no other
source of income.

2. That I am exempted from filing my income tax returns as provided for by the
Philippine Internal Revenue Code.

3. That I executed this affidavit to attest to the truth and veracity of the foregoing
facts and not for FRAUD and for whatever legal purpose it may serve.

AFFIANT FURTHER SAYS NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this ______________ at

Quezon City, Metro Manila, Philippines.

____________________________
Affiant

SUBSCRIBED AND SWORN to before me on the date and place above

indicated.

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