REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SULTAN KUDARAT)S.S

MUNICIPALITY OF ISULAN)
X------------------------------------------------X

AFFIDAVIT-DECLARATION OF
CURRENT YEARS GROSS INCOME

That I, SUSIE M. FIGURACION, of legal age, Filipino, married and a resident of

Valdez, St., Kalawag II, Isulan, Sultan Kudarat, after having been duly sworn to in accordance
with law, do hereby depose and say;

1. I receive professional/talent/service fees as _______________________;

(Please check appropriate box/s)

Practice of profession or calling

Professional entertainer

Professional Athlete

Insurance agents and adjusters

Other: Specify Not Practice in Profession

Management & Technical consultants

Bookkeeping agents and agencies

Other recipient of talents fees

Director who is not an employee on the company

Juridical person in the practice of profession

2. A such, I have received a gross income of P1, 292, 405.69 on sales both hospital
& pharmacy.

That I am executing this Affidavit-Declaration as a requirement of Revenue

Regulation No. 30-2003 of the Bureau of Internal Revenue in the Determination of
the application creditable with holding tax rate (10% or 15%) to be imposed by
withholding agents.

IN WITNESS WHEREOF, I have hereunto set our hands this ___ day of
___________, 2009 at Isulan, Sultan Kudarat.

SUSIE FIGURACION
Affiant
CTC. NO.___________
Issued on. ___________
At _________________

SUBSCRIBED AND SWORN TO, before me this ____ day of _________ 2009
at Isulan, Sultan Kudarat, Philippines.
 ARNOLD H. ARMADA
Doc No. 245; Notary Public
Page No: 50; Until December 31, 2010
Book No. 80; PTR NO.0981481/01-07-09/Isulan
Series of 2009 IBP NO.738513/11-03-08/Isulan
ROLL NO. 38861/3-14-1994