Annex "C

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF
CITY/MUNICPALITY OF

i, Nadala Nelson Montilla, Filipino, of legal age designated as Technician of J.K.L INK
REFILLING SERVICES, with business address located at #89 Dejesus Comp. Brgy Sta. Quiteria
Caloocan City do hereby certify the following:

That in compliance with the requirements of Revenue Regulations No. submitted

herewith is/are (USB) containing (Number of Scanned BIR Form 2307/2316) covering
the period January /01/2022.

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.

HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING

ATTESTATIONS ARE TRUE AND CORRECT.

SUBSCRIBED and sworn to before me, in the City/MunicipaIlty of of , 20 by with , this

Residence Certificate No. day
issued
at
Name and Signature of
Authorized Representative
TIN:

Notary public BUREAU OF INTERNAL REVENUE.

Doc. No. RECORDS MGTr mv1s10N

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