Annex “C”

SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES

PROVINCE OF CEBU
CITY/MUNICIPALITY OF CEBU

I, HELARIO AMIG IYOG, Filipino, of legal age, designated as proprietor of of Rods Quality Movers
and Delivery Services with business address located at #38A Plaridel St., Umapad, Mandaue City do
hereby certify the following.

1. That in compliance with the requirements of Revenue Regulations No. 2-2015, submitted
herewith is/are 1 USB containing 34 scanned BIR Form 2316 covering period
12/31/2022.

2. That the contents of the USB being submitted herewith conform to the
conditions/specification requirements set by the Bureau of Internal Revenue

3. That the soft copies of the BIR Form 2316 contained in the USB being submitted
herewith are the complete and exact copies of the original thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE

FOREGOING ATTESTATIONS ARE TRUE AND CORRECT.

__________________________________
Helario Amig Iyog
254-244-672-000

SUBSCRIBED and sworn to before me, in the City/Municipality __________________, this

day of ___________, 20_____ by___________________with Residence Certificate No.
___________issued at ______________, of___________20_____.

Notary public
Doc No. _____________
Page No. _____________
Book No. _____________
Series of ______________