Annex “C”

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF PANGASINAN
CITY/MUNICIPALITY OF BURGOS

I, ERNESTO P. CABUDOY, Filipino, of legal age designated as Principal IV of Burgos National High School,
with business address located at Poblacion, Burgos, Pangasinan, do hereby certify the following:

- That in compliance with the requirements of Revenue Regulations No. 2-2015, submitted
herewith is/are (2) two DVD-Rs containing 56 copies of scanned BIR form 2307/2316
covering the period 12/31/2022.

- That the contents of the DVD-Rs being submitted herewith conform to the
conditions/specification requirements set by the Bureau of Internal Revenue.

- That the soft copies of the BIR Form 2307/2316 contained in the DVD-R/s being submitted
herewith are the complete and exact copies of the original thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING ATTESTATION
ARE TRUE AND CORRECT.

ERNESTO P. CABUDOY
Name and Signature of Authorized Representative
TIN: 130-251-132-000

SUBSCRIBED and sworn to before me, in the City/Municipality of____________, this day of
____________________, 20______ by _____________________________ with Residence Certificate
No. _____________________ issued at ______________________________ of
___________________________ 20________.

Notary Public
Doc. No. __________
Page No. __________
Book No. __________
Series of __________