SWORN DECLARATION

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ILOCOS SUR )S.S
MUNICIPALITY OF NARVACAN )

I, IRENE D. CABALO, FILIPINO, of legal age designated as DOFREDO’S DRY GOODS,

with business address located at Narvacan, Ilocos Sur do hereby certify the following:

 That in compliance with Section 13 Revenue of Regulations No. V-1, otherwise known
as Bookkeeping Regulations, submitted herewith is the DVD-R containing the summary
list (s) schedule (2) of inventory (stocks-in-trade), materials supply and other good etc.
and/or other schedules (applicable schedules) as of taxable year ending December 2020.

 That the contents of DVD-RS being submitted herewith conform to the prescribed format
as required by the Bureau of Internal Revenue under Memorandum Circular No. 57-2015.

 That the summary lists (s) schedule (s) of inventory and/or others schedules has been
made in good faith, verified by us, and to the best of our knowledge and belied, is true
and correct pursuant to the provisions of the NCR, as amended, and the rules and
regulations and other revenue issued under authority thereof.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE

FOREGOING ATTESTATIONS ARE TRUE AND CORRECT.

IRENE D. CABALO
Name and Signature of Authorized
Representative
TIN: 482322370

SUBSCRIBED and sworn to before me, in the City/Municipality of Narvacan, Ilococs

sur, this ______ day of January, 2021 with Residence Certificate No. 22874130. Issued at
Narvacan, Ilocos Sur, on January, 2021.

Doc. No. _____

Page No. _____
Book No._____
Series of 2021