REPUBLIC OF THE PHILIPPINES)

CITY O F DAVAO ) SS.

AFFIDAVIT-DECLARATION
OF CURRENT YEARS GROSS INCOME

I, MANUEL B. BASABE JR., of legal age, Filipino, single and a resident

of Purok 11, So Nio, Barangay 76-A, Buacana, Davao City, under oath state
that:

1. I receive professional/ service fee as an Invigilator of British Council

with business address at 10F Taipan Place, F. Ortigas Jr. Road,
Ortigas Center, Pasig City, 1605, Philippines;

2. As such, I have received a gross income of Forty Thousand Pesos

Only (Php 40,000.00) for the current years as of May 2016;

3. I am executing this Affidavit-Declaration as a requirement of

Revenue Regulations No. 30-2003 of the Bureau of Internal
Revenue in the determination of the applicable creditable
Withholding tax rate (10% or 15%) to be imposed by withholding
agent/s; and

4. I am further executing this affidavit to attest to the truth of the

foregoing narration of facts for whatever legal purpose this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

________________ at Davao City, Philippines.

MANUEL B. BASABE JR.

Affiant

SUBSCRIBED AND SWORN to before me this ________________ at

Davao City, Philippines, affiant exhibiting to me his PhilHealth Id No. 16-
050574442- 7 as his competent evidence of identity.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2016.