Republic of the Philippines

City of Cauayan

CERTIFICATION UNDER OATH

I, ----------------, Filipino, of legal age, married,with address at Minante I, Cauayan city,

Isabela, after having been duly sworn in accordance with law, hereby, depose and say:

1. That I am the Chairperson of the ================== Cooperative, duly

organized and existing under the Cooperative Development Authority and laws of
the Philippines with office address at =====================.

2. That the following names of the members with their corresponding capital
contribution are as follows:

Name of the Member TIN Number Amount of Capital

Contribution

TOTAL

3. That the said cooperative has applying for application for Certificate of Tax
Exemption to the Bureau of Internal Revenue under Revenue Memorandum Circular
No. 102-2016 amending the Revenue Memorandum Order No. 76-2010 and
Revenue Memorandum Circular No. 81-2010.
 4. That this affidavit is being executed in order to attest to the truth of the foregoing
circumstances and for the purpose of complying with the requirement for applying
said application.

In witness whereof, affixed hereto signature this ___ of _______________at

Affiant

SUBSCRIBE AND SWORN to before me this ____ day of ____________ exhibiting to me her
_________ issued on at _____________ in.

Doc No._________
Page No.________
Book No. _______
Series of 2021

Republic of the Philippines

City of Cauayan

CERTIFICATION UNDER OATH

I, SOLEDAD M. ACOSTA, Filipino, of legal age, married, with address at Minante I, Cauayan
city, Isabela, after having been duly sworn in accordance with law, hereby, depose and say:

1. That I am the General Manager of the Cagayan Valley United Marketing Cooperative ,
duly organized and existing under the Cooperative Development Authority and laws
of the Philippines with office address at Minante I, Cauayan City, Isabela.

2. That Cagayan Valley Marketing Cooperative is transacting business to its members

only.

3. That the accumulated general reserves and undivided net savings of the cooperative
as of December 31, 2019 totaled amounting to Three Hundred Fifty Thousand Five
Hundred Twenty One pesos & 15/100 (Php 350,521.15).

4. That at least 25% of the net surplus is being retained to members in the form of
interest on capital and a patronage refund.

5. That this affidavit is being executed in order to attest to the truth of the foregoing
circumstances and for the purpose of complying with the requirement for applying
said application.

In witness whereof, affixed hereto signature this ___ of _______________at Cauayan City,
Philippines.

Soledad M. Acosta
Affiant

SUBSCRIBE AND SWORN to before me this ____ day of ____________ exhibiting to me her
_________ issued on at _____________ in Cauayan City, Isabela.

Doc No._________
Page No.________
Book No. _______
Series of 2021