ANNEX A

SWORN STATEMENT
REPUBLIC OF THE PHILIPPINES
PROVINCE OF ________________________________
CITY/MUNICIPALITY OF _________________________
I (Name of Authorized Representative), (Nationality), of legal age designated as (Position) of (Registered
Business/Trade Name of Company/Corporation), with registered address located at _(registered/residence address),
do hereby certify the following:

THAT, (Name of Company/Owner/Corporation) with business address

address)___________ is a duly registered entity under the laws of the Philippines;

at

_____(business

THAT the company is engaged in Printing Services and existing under (business/trade name), with TIN
____________________ and has been operating for no less than three (3) years in printing the principal
and supplementary invoices/receipts;

THAT the company owns __(number of machines)___ number of machines for printing of the principal and
supplementary invoices/receipts, please specify serial numbers, description of each printing machine;

THAT the companys printing machines are capable of generating security features/ markings in printing of
the principal and supplementary invoices/receipts;

THAT the company shall only print customers or clients principal and supplementary invoices/receipts
with an Authority to Print secured from the BIR;

THAT the company shall not require a minimum number of booklets for printing for its customers/clients;

THAT the aforementioned principal and supplementary invoices/receipts to be printed are serially
numbered and conformed to the requirements of Sections 237, 238, and 113 (for VAT-registered taxpayer)
of the National Internal Revenue Code of 1997, as amended and other prevailing rules and regulations;

THAT the company will comply with the provisions of the bookkeeping regulations and reportorial
requirements of the BIR;

THAT the company, or any of its owners, is not connected with the BIR or is not related to any BIR official
or employee within the fourth civil degree of consanguinity or affinity or the latters relatives within the
fourth civil degree of consanguinity or affinity.

THAT in the event that the foregoing be discovered to be in violation of existing rules and regulations, I
hereby undertake to face any legal sanctions and pay corresponding penalties thereof as provided for under
the National Internal Revenue Code of 1997, as amended.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE FOREGOING

ATTESTATIONS ARE TRUE AND CORRECT.
__________________________
Name and Signature of Affiant/Authorized
Representative
TIN: __________________
SUBSCRIBED and sworn to before me, in the City/Municipality of ____________________, this day of
____________, 20___ by ______________ with Residence Certificate No. _________ issued at _____________
on, __________ 20 ___.
Notary Public
Doc. No.
Page No.
Book No.
Series of

___________
___________
___________
___________

ANNEX A