PCNC Form 102

Republic of the Philippines )

City of ________________ ) S.S.

AFFIDAVIT OF VERIFICATION

I, SHERWIN T. MERCA, Executive Director/President of NIELS AND NELSON SCHOLARSHIP

FOUNDATION INC, declare under penalty of law that all matters set forth in this Application for
Accreditation have been made in good faith, duly verified by me, and to the best of my knowledge
and belief are true and correct.

I hereby attest that all the information in this Application for Accreditation and all
attachments thereto are being submitted in compliance with the Accreditation Standards of the
Philippine Council for NGO Certification, Inc. (PCNC) in accordance with the rules and regulations of
the Bureau of Internal Revenue (BIR), particularly Revenue Regulations No. 13-98, the collection,
processing, storage and sharing of said information being necessary to carry out the functions of said
agencies for the performance of the constitutionally and statutorily mandated functions of the BIR
as a regulatory agency.

I further attest that I have been authorized by the Board of Trustees to file this Application
for Accreditation with the PCNC as an Accrediting Entity.

Done this ___ day of ___________, 20 _____ in ________________________________.

_________________________________
(Signature over printed name)

SUBSCRIBED AND SWORN TO before me in _______________________ on

____________________ by affiant who personally appeared before me and exhibited to me his/her
competent evidence of identity consisting of _________________ issued at _________ on
____________.

NOTARY PUBLIC

Doc. No. _________;

Page No. _________;
Book No._________;
 PCNC Form 102

Series of _________.