Name of Firm

Address

SWORN STATEMENT OF THE CURRENT AND FAIR

MARKET VALUE OF REAL PROPERTIES (MACHINERIES)
(Taxable or Exempt)

Required under Section 203, Chapter 2 Title Two Book II of Republic Act No. 7160
otherwise known as the Local government Code of 1991 which read as follows:

“Sec. 203 – Duty of Person Acquiring Real Property or Making Improvement thereon. - It
shall be the duty of any person, or his authorized representative, acquiring at any time real property
in any municipality or city or making any improvement on real property, to prepare, or cause to be
prepared, and file with the provincial, city or municipal assessor, a sworn statement declaring the true
value of subject property, within sixty (60) days after the acquisition of such property or upon
completion or occupancy of the improvement, whichever comes earlier.”

Item Description Date of Original Present

Qty Acquisition Operation
Described in Sufficient Cost Market Value

I HEREBY CERTIFY that the above value are the correct and true market value of the real
property listed.

PREPARED BY CERTIFIED CORRECT:

Certified Public Accountant OWNER /MANAGER

(Affiant)
Original cost of acquisition on the machineries includes costs of freight and insurance charges, bank charge,
brokerage, arrastre and handling, custom duties and taxes plus cost of inland transportation handling and installation
charges on the present site.

SUBSCRIBED AND SWORN to before me, at the City of Iligan, Philippines, this
_________th day of ____________________, 2002, the affiant exhibiting his/her residence
certificate No. _______________________, issued at _______________________ on
__________________, 2011.

________________________________
Administering Officer

NOTE: If space above is not sufficient attached supplemental sheets.

 Name of Firm

Address

SWORN STATEMENT OF THE CURRENT AND FAIR

MARKET VALUE OF REAL PROPERTIES (BUILDING OR IMPROVEMENT)
(Taxable or Exempt)

Required under Section 203, Chapter 2 Title Two Book II of Republic Act No. 7160
otherwise known as the Local government Code of 1991 which read as follows:

“Sec. 203 – Duty of Person Acquiring Real Property or Making Improvement thereon. - It
shall be the duty of any person, or his authorized representative, acquiring at any time real property
in any municipality or city or making any improvement on real property, to prepare, or cause to be
prepared, and file with the provincial, city or municipal assessor, a sworn statement declaring the true
value of subject property, within sixty (60) days after the acquisition of such property or upon
completion or occupancy of the improvement, whichever comes earlier.”

Kind of Building Area Item Description Date of

Qty Amount
or Improvement (Sq. m.) (material used) Construction

I HEREBY CERTIFY that the above value are the correct and true market value of the real
property listed.

PREPARED BY CERTIFIED CORRECT:

Certified Public Accountant Owner/ Manager

(Affiant)
Original cost of acquisition on the machineries includes costs of freight and insurance charges, bank charge,
brokerage, arrastre and handling, custom duties and taxes plus cost of inland transportation handling and installation
charges on the present site.

SUBSCRIBED AND SWORN to before me, at the City of Iligan, Philippines, this
_________th day of ____________________, 2002, the affiant exhibiting his/her residence
certificate No. _______________________, issued at _______________________ on
__________________, 2011.

________________________________
Administering Officer

NOTE: If space above is not sufficient attached supplemental sheets.