ANNEX "At INCOME PAYEE’S SWORN DECLARATION OF GROSS RECEIPTS/SALES (For Self-Employed and/or Engaged in the Practice of Profession with Lone Income Payor) ie TEU Wi. SUB JA vA of legal age, single! married to THLIOA B PUR/AGA —___ponmeriyrsitngn_J2 ¢ Sa AVZO- 2 SAEKAY, cmaApID SUR. = ith Tespyer Keeton ber TN) fer having ben hy sven crs wi ew hherchy depose and state: 1. That derived my JEW /¢/fas income only stom PMLIZVAIE SCHL CE HUGH Serbo e- with Taxpayer dentition Number G25 G62 "O99 and business addressat_ZAGOMG OG , 604 eArnAp Mite Cte ‘ 2. That forthe current year 20/9 _. my gross receipts wil not exceed Two Hundred Fifty Thousand Pesos (P2S0,000.00) and that 1am registered asa non-VAT taxpayer hat whatever isthe amount o come received, | wil eomply with the requiem file my Income Tax Return on the prescribed due dat. “or ths purpose, | pt to avai o either one othe following Graduated Income Tax Rates under Section 2442) othe Tax Code as amended, based on te taxable income. With this election, | acknowledge that Lam subject 1 0% neo ne tx, thes, no subject o credible withholding lax, subject te perentage a, if applic ibe, and will ile the required percentage tax returns or sues to withholding petcenage lx, im ease of government mocey payments. Gat Percent (8%) income tax rate under Section 24(42)(5) of the Tax Code, as amended, based on gross receipts/sales and other non-operating income - with this selection, | understand tha this iin eu ofthe graduated income tax rates and the Percentage Tax under Section 116 of the Tax Cove, 25 amended, sus, no withholding tax shall be made; 3. That based on my selection above, iy gross sles/recepts and other non-operaing income exceeds P250,000 00 bu ot over 3,000,000 00, ‘my afre-sated lone income payo: shall automatically withhold tx prescribed rate of withholding tx 1, Incase of Graduate Incose Tax Rates, acknowledge tt aside from income tax, fam subjet to business tax (Peroentage “Tax, if applicable) and creitable withholding of income in exces of P2$0,000 00 and business tax wiolding, i any, are aplicable onthe etre income payment, OR b. Incase of ight Percent (8%) income tx ate, [acknowledge that am ony subjectto income tax and thus, tthe creditable withholding income ta in excess of P250,000 0; 4. That | duly execute this SWORN’ DECLARATION in ccmlance with the requirement presribed under Section of Revenue Repulations No. fs ‘5. That declare, under the penalties of perjury, that this deslrat x tas been made in god faith and tothe best of my knowledge and belie to be true and comect, INWITNESS WHEREOF, Ihave erent set my hand tis /# cayof_ MAY erent in pom ce AI conune moe Applicantexhiited WWE A. LORAYES- VILLAR P ATTORNEY It (EDD TTT-G007) Fa TT