A NNEX "C"

SWORN DECLARATION
REPUBLIC OF THE PHILIPPINES
PROVINCE OF METRO MANILA

I, NAME OF SIGNATORY , Filipino, of legal age designated as POSITION SIGNATORY of NAME OF COMPANY, with
business address located at COMPANY ADDRESS , do hereby certify the following:

That in compliance with the requirements of Revenue Regulations No. 02-2015, submitted herewith is/are one (1)
DV D-R containing ___________ covering the period of 12/31 /202 2
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 2316 contained in the DVD-R/s being submitted herewith are the complete and
exact copies of the original thereof.

I HEREBY DECLARE UNDER T HE PENALT IES OF PERJURY T HAT T HE FOREGOING AT T EST AT IONS ARE T
RUE AND CORRECT .

SIGNATORY
TIN:

SUBSCRIBED and sworn to before me, in the City/Municipality of _________________________, this day of
__________________, ________ with __________________________________________________________________
issued by, on _______________________________________________________________________.

NOTARY PUBLIC
Doc. No.________
Page No.________
Book No.________
Series of________