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Affidavit For PWD Exemption

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REPUBLIC OF THE PHILIPPINES)

TAGUIG CITY ) S.S.

SWORN DECLARATION
TO CLAIM TAX EXEMPTION FOR QUALIFIED DEPENDENT PWD

I, _________________, of legal age, Filipino, married and resident of


_____________________, after having been sworn to in accordance with law, depose and
state that:

1. I was previously married to _______________ and our marriage was annulled


_______________
2. I have since remarried to _______________ on _______________
3. _______________ and I have _______________ children, namely _______________
_______________ years of age and _______________ _______________ years of
age.
4. Since early childhood, _______________ has been diagnosed with _______________
5. I have sole custody of both _______________, and I am singlehandedly providing
financial support for the children. The children currently reside with me in
_______________
6. I am presently employed and earning purely compensation income.
7. In view of Republic Act No. 10754 (An Act Expanding the Benefits and Privileges of
PWD), I intend to file for additional tax exemption for my qualified dependent
_______________
8. I hereby declare under penalty of perjury that the foregoing representations are true and
correct and undertake to duly inform the Bureau of Internal Revenue for any change in
the arrangement with regards to the support and custody of my declared dependent
PWD child.

IN WITNESS WHEREOF, I have hereunto set my hand in the


city of Taguig, Philippines this ___________________ .

_______________
Affiant

SUBSCRIBED AND SWORN to before me this ___________________ ,


in the city of Taguig City, Philippines, affiant identified by me through her Competent
Evidence of Identity:
BIR Taxpayer I.D. No. 199-505-356
Doc. No: ________ ;
Page No: _______ ;
Book No.: _______ ;
Series of 2017.

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