AFFIDAVIT DECLARATION

OF CURRENT YEARS GROSS INCOME

Republic of the Philippines
______________________

) SS

I,
, of
legal
age, single/married, residing
at
__________________________________________________________, after being sworn in accordance with
law, depose and say that:
1.

I am a TALENT for which I receive talent fees;

2.

As such, I have received a gross income of P

_____________, 20___.

3.

I am executing this Affidavit-Declaration as a requirement of Revenue Regulation 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
_______, 20___ in

WHEREOF, I
have
hereunto
____________________, Philippines.

for the current year as

set

my

hand

this

day of

______________________________________
Affiant-Declarant
TIN: ___________________
SUBSCRIBED and sworn to before me, in ________________, this ____ day of _____, 20___
Government issued ID of _____________ with No. ______________________issued at
____________________on _________________, 20___.

Notary Public
Doc. No. : ________
Page No. : ________
Book No. : ________
Series of 20________.

of