REPUBLIC OF THE PHILIPPINES )

PROVINCE OF BATANGAS ) S. S.
CITY OF TANAUAN )

AFFIDAVIT OF NON-FILING OF INCOME TAX RETURN

I, ABC, 32 years of age,married, Filipino Citizen, and resident of Barangay Sambat, Tanauan
City, Batangas, after having been sworn to in accordance with law, hereby depose and say THAT:

1. I am the aunt of XYC;

2. The parents of XYC abandoned her,

3. I then took custody of XYC and acted as her guardian;

4. XYC is an incoming 4th year college student at Batangas City State University (BSU),
Malvar, Batangas; and she is applying for a scholarship program of thereat;

5. One of the requirements of said scholarship program is a proof of the Bureau of

Internal Revenue (BIR) validated Income Tax Return (ITR) of parents/guardian;

6. I did not file an ITR at the BIR because I as a helper at a canteen my income is barely
enough for our every day needs. We also belong to the indigent families in our
barangay. To prove this allegation, hereto attached is a photocopy of my Certificate of
Indigency from our Barangay

7. I am executing this affidavit to attest to the truth of all the above facts, to support the
application of XYC, and for all legal intents and purposes it may serve.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this June 30, 2017 at Tanauan
City, Batangas, Philippines.

ABC
Affiant

SUBSCRIBED AND SWORN to before me this June 30, 2017 at Tanauan City,
Batangas, Philippines, affiant exhibiting to me her Voters ID with No. H0384LMM20001-8,
bearing her picture and signature to prove her identity.