Republic of the Philippines )

City of __________________ )S.S

AFFIDAVIT

I, ______________________________________, of legal age, Filipino, with office address at,

after having been duly sworn to in accordance with law, do hereby state:

1. That am the current.

2. That in accordance with my authorized function as, I have filed with the Bureau of Internal
Revenue of Pasay City (“BIR”) the payment of the following taxes on behalf of our client
(hereinafter collectively referred to as the “BIR Forms”)

3. That I hereby confirm that the Tax Identification Number (“TIN”) indicated in the abovementioned
transactions with the BIR

4. Upon checking with the records of;

5. Upon discovery of the error made on the TIN of

6. That I hereby confirm that the error on the TIN of

7. That I further affirm that the payment of the Withholding Tax with an amount of Php303,750.00
and Documentary Stamp Tax with the amount of PhP91,125.00 are both intended for the
payment of the transactions for the account of.

8. That I am executing this Affidavit to attest to the truth of the foregoing facts and to use the same
for purposes of correcting the TIN of

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have affix hereunto my signature on

at .

Affiant

SUBSCRIBED AND SWORN TO before me on this ______ affiant exhibiting to me

her issued on at
.

NOTARY PUBLIC

Doc. No. ;
Page No. ;
Book No. ;
Series of ______.