REPUBLIC OF THE PHILIPPINES

____________________

DRAFT
ONLY!

)
) SS.

AFFIDAVIT
I, ______________(Name of Self-Employed Professional), Filipino, of legal
age, single/married to _________________, and a resident of ____________________
_____________________________, after having been duly sworn in accordance with
law, hereby depose and say:
1. That I am a Certified Public Accountant (CPA) with TIN ______________, duly
registered with the Bureau of Internal Revenue under RDO ___- ___________
and
practicing
my
profession
in
my
office
address
at
______________________;
2. That as a CPA, I render professional services to a number of clients, and that
my fees range from P___________ to P___________ (ex.P200.00
P5,000.00);
3. That, I bill my clients by issuing them, Service Invoices that are duly
registered with the BIR, and upon payment thereof, I issue the corresponding
Official Receipt/s;
4. That, the factors I consider in determining the equitable rate of fees charged
or to be charged are: the complexity of the work performed or to be
performed, the extent of responsibility assumed, the volume of work number
of hours spent or to be spent in doing the work, the nature of the engagement
assurance or non-assurance, etc; and
5. That this affidavit is hereby executed to attest to the truth of the facts abovestated, and in compliance with the dictates of BIR Revenue Regulations No.
4-2014.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of
____________, 2014 at ______City, ___________ Province, Philippines.

_____________________________

SUBSCRIBED AND SWORN TO before me, a notary public in and for

_____________________ this ____ day of ____________ 20___. The affiant, whom I
identified through the following competent evidence of identity: _________________,
valid from ____________ to ___________ issued by ________________, personally
signed the foregoing instrument before me and avowed under penalty of law to the
whole truth of the contents of said instrument.

NOTARY PUBLIC
Doc. No. ..;
Page No. .;
Book No. .;
Series of 20__.