Republic of the Philippines )

City/Municipality of _____________ )

AFFIDAVIT

I, ____________________, of legal age, Filipino, single, with business address at

__________________________________________________, after having been duly
sworn to in accordance with the law, hereby depose and say that:

(1) That I am a Lawyer by profession and registered with the Bureau of

Internal Revenue RDO __, Municipality of _____________ with Tax
Identification No. ____________________.

(2) That I am currently holding place of work at

_____________________________________________.

(3) That on March 3, 2014, the Bureau of Internal Revenue released

Revenue Regulation No. 4-2014 Guidelines and Policies for the Monitoring of
Service fee of Professionals;

(4) That I charge the following professional fees to my client:

a) Appearance fee PHP 3000

b) - PHP 3,000
c) Notary Public Fees PHP 100

The above-rates would vary depending on the classification, relation of

client, difficulty of cases, length of service, and profit-sharing agreements arising
from the Emloyer .

(5) That the manner of billing for is through the office;

(6) That professional fees paid by Senior Citizens/PWDs are discounted

by 20%;

(7) That I am executing this affidavit to attest to the veracity of the

foregoing facts and for all intents and for whatever legal purpose it may serve.

THIS INSTRUMENT/DOCUMENT was personally subscribed and sworn to by the

affiant before me this _______________, in ________________ City. Affiant, who is
personally known to me avowed under penalty of law to the whole truth of the contents
of the foregoing document/instrument, and exhibited her
_______________________(government-issued ID with photograph and signature)
which is valid until _______________________.

IN WITNESS WHEREOF I have hereunto set my hand and affixed my Notarial Seal on
the date and place first above written.

Doc. No. ___________;

Page No. ___________;
Book No. ___________;
Series of 2015.