BIR 2316 Declaration Statement

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Declaration / Sworn Satement

This is to certify that I, Mr. / Ms. __________________________________________ of


legal age, ______________________, with postal address at ______________________
_________________________________________________________________________ and
presently working with IBEX Global Solutions Philippines Inc., as ________________________
with Tax Identification Number __________________, certify that:

I have no previous employment within the year prior to IBEX Global Solutions Philippines Inc..

More so, I made this statement to free the “Company” from any fault or violation
pursuant to the provisions of the National Internal Revenue Code, as amended, and the
regulations issued under authority thereof:

Signed this ______ day of ________________, 20____ at _________________.

_____________________________

Employee’s signature over printed name

IN WITNESS WHEREOF, I have hereunto set my hand this day of , 20 , in


____________________, Philippines.

_________________________
(Signature over printed name)

SIGNED IN THE PRESENCE OF:

_____________________________ _____________________________
ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)


_____________________________) S.S

BEFORE ME, a Notary Public for and in the ________________, ________ City,
personally appeared__________________________, with Community Tax Certificate
No._____________ issued on ______________ at _____________, known to me and to
me known to be the same person who executed the foregoing instrument and they
acknowledged to me that the same is their free and voluntary act and that of the
corporations represented.

WITNESS MY HAND AND SEAL on the date and at the place first written above.

Doc. No. _______;


Page No. _______;
Book No. _______;
Series of 20____.

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