AFFIDAVIT – DECLARATION
OF CURRENT YEAR’S GROSS INCOME
Republic of the Philippines
)
Province of ___________________)
City/Municipality of ____________)
I, _______________________ also known as ___________________, of legal age,
single/married, residing at _______________________________________after being sworn in
accordance with law, depose and say that:
1. I receive professional / talent / service fees as _____________________________
(please check box/es):
/
/
/
/
/ Practice of Profession
/ Professional Entertainment
/ Professional Athlete
/ Director
/
/
/
/
/
/ Others: Specify __________
/
/ Management & Technical Consultants
/ Bookkeeping agents and agencies
/ Other recipients of talent fees
/ Director who is not employee of the
company
/ Judicial person in the practice of
profession
2. As such, I have received a gross income of P____________________ for the
current year as of _________________.
3. I am executing the 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.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________ day of
______________, in the Municipality of______________ province of ______________
Philippines.
Affiant – Declarant
TIN: ___________
SUBSCRIBED AND SWORN to before me, in ______________, this _____ day
of _________________ with Community Certificate No. _______________ issued at
_________________ on ______________, 20____.
Doc. No. _______
Page No. _______
Book No. ______
Series of 20_____