Republic of the Philippines }

Quezon City, Metro Manila} S.S.

AFFIDAVIT OF NON-FILING OF INCOME TAX RETURNS

I, _________________________, Filipino, of legal age, single/married, with residence

address at _________________________________________________________________,
after having been duly sworn in accordance with law, hereby depose and say:

1. That I have not been employed since _________ and I have no fix of income as a
_____________________.

2. That I have a monthly income of _________________ and my estimated annual

gross income is ___________________.

3. That I am exempted from filing my income tax returns as provided for by the
Philippine Internal Revenue Code.

4. That I executed this affidavit to attest to the truth and veracity of the foregoing
facts and not for FRAUD and for whatever legal purpose it may serve.

AFFIANT FURTHER SAYS NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this ______, 20____ at

Quezon City, Metro Manila, Philippines.

____________________
Affiant

SUBSCRIBED AND SWORN to before me on the date and place above indicated.

Notary Public
Doc. No.
Page No.
Book No.
Series of ______