REPUBLIC OF THE PHILIPPINES)

City of Bacolod )
x--------------------------x

AFFIDAVIT

I, PETER JAKE, of legal age, Filipino and a resident of

Bacolod City, under oath-

DO HEREBY CERTIFY

That I am the President of OCTAGON CORPORATION, a domestic

corporation organized and existing under the laws of the
Philippines, which principal business address at, Bacolod City:

That I hereby submit the required REPORTORIAL REQUIREMENT

FOR ESTABLISHMENT LEASING OUT SPACES FOR COMMERCIAL ACTIVITES
under Sec. 2 Revenue Regulation No. 12-2011 dated July 25, 2011
to the BIR Revenue District Office (RDO) Bacolod and I hereby
submit the following information in hand, to wit:

a. The Lessee Information Statement sheet.

That I hereby certify as to the correctness and validity of

the above information pertaining to the above-mentioned reports
under such proper and appropriate compliance thereof.

IN WITNESS WHEROF, I have hereunto set my hand this

_______________ at Bacolod City.

President

SUBSCRIBED AND SWORN to before me this ___________________

at Bacolod City. Affiant exhibited to me his valid
identification, ______________ No. ________________ issued by
______________________

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