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Sworn Declaration eSALES1

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-Annex “ A “

SWORN DECLARATION

The Revenue District Officer


Revenue District No. 25B – EAST BULACAN

Sir/ Madam:

In compliance with your requirements on the enrolment with the eSales system, below is our
designated authorized user as Mr. _________________________________________ for
Head Office and branches of such system:

BRANCH TIN : _____________________


USERNAME : _____________________
FIRST NAME : _____________________
MIDDLE NAME : _____________________
LAST NAME : _____________________
EMAIL ADDRESS : _____________________
TRANSACTION NO : _____________________

For your information and reference.

_____________________
_____________________
TIN: _____________________
Adress_____________________
Tel. No. _____________________

Subscribed and sworn to before me, in the City/Municipality of _______________________.


this day of _________________, 20___ by_____________________ with Residence
Certificate No. _________________ issued at____________________ on, ____________
20____.

Notary Public

Doc No._______
Page No._______
Book No. ______
Series of _______

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