REPUBLIC OF THE PHILIPPINES
CITY/MUNICIPALITY OF [City/Municipality]
SWORN STATEMENT
I, [Name of Affiant], of legal age, [civil status], and a resident of [Address], after having been duly sworn in accordance with law, hereby depose and state that:
I am the [Position] of [Name of Business], a business entity duly organized and existing under and by virtue of the laws of the Republic of the Philippines, with principal office located at [Business Address].
The business is registered with the Bureau of Internal Revenue (BIR) under Tax Identification Number (TIN) [TIN of Business].
[Name of Business] has been using a Point of Sale (POS) system with the following details:
Brand/Model: [Brand and Model of POS]
PTU Number: [PTU Number]
Date of Issuance: [Date of Issuance]
Serial Number: [Serial Number of POS]
Due to [Reason for Cancellation - e.g., change in business operations, upgrade to a new system, cessation of business], we are requesting the cancellation of the Permit to Use (PTU) for the aforementioned POS system.
The said POS system will be [Action on the POS - e.g., returned to the supplier, disposed of properly, stored securely] following the cancellation of the PTU.
We hereby commit to comply with all the requirements and obligations set forth by the BIR in relation to the cancellation of the PTU.
Attached herewith are the supporting documents for the cancellation request, including:
Original PTU Certificate
Photocopy of BIR Certificate of Registration
Inventory list of transactions processed through the POS (if applicable)
Other relevant documents
I am executing this affidavit to attest to the truth of the foregoing statements and for the purpose of requesting the cancellation of the PTU of our POS system.
IN WITNESS WHEREOF, I have hereunto set my hand this [day] of [month], [year], at [place].
[Affiant's Name]
[Position]
[Name of Business]
[Signature]
SUBSCRIBED AND SWORN TO before me this [day] of [month], [year], at [place], affiant exhibiting to me his/her [Government-issued ID, e.g., Driver's License, Passport] issued on [date of issuance] at [place of issuance].
NOTARY PUBLIC
Doc. No. ____
Page No. ____
Book No. ____
Series of ____
This sworn statement should be filled out with accurate details pertaining to the specific business and the POS system in question. It must be signed by the affiant and notarized to be legally binding.
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