REPUBLIC OF THE PHILIPPINES)

)S.S.
x-----------------------------------------------------x

AFFIDAVIT
I, __________________________, of legal age, Filipino, and a resident of
____________________________________, Philippines after first being sworn to in
accordance with law hereby depose and state:
1. From 1989 to _____________________, I was working in the Embassy of
the Philippines in Tehran, Iran;
2. Being an OFW, I did not file my Income Tax Returns (ITR) during the
above-mentioned period;
3. From years 2013 to 2014, I did not work for any company nor was I
engaged in any business.
4. I am executing this affidavit in lieu of the requirement of the Philippine
Overseas Employment Administration to submit my ITR for the year
2013 and 2014 for our company, ALPHASONIC INTERNATIONAL
MANPOWER AGENCY, INC.
IN WITNESS WHEREOF, I have hereunto set my hand this ____________________
at ____________________, Philippines.
______________________________
Affiant
SUBSCRIBED AND SWORN to before me this _____________________, in the
_____________, Philippines.
NOTARY PUBLIC
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2015.