Legal Sworn Statement Template - Free Download
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PUBLIC' ''''' Ref:%RBWM_12Feb2013_0159'
I, ___________________________________, of legal age, currently residing at
______________________________________________________________________, after having
been duly sworn in accordance with law, do hereby depose and state that:
1. I am a non-resident Filipino citizen/ Overseas Filipino Worker (OFW) with proof of permission to
work abroad as evidenced by my _______________________________ (choose any of the
following if applicable: Working Visa, Working Permit, POEA ID or POEA Certificate) with number
2. My source of income is from outside the Philippines and I do not derive any income from
Philippine sources. As such, I am not required to file an Individual Income Tax Return (ITR) in the
3. Likewise, I have never applied for and been issued a TIN.
4. I am executing this Sworn Statement to attest to the truth of all the foregoing statements and for
whatever legal purposes it may serve.
5. I undertake to immediately inform HSBC and submit the ITR annually in the event that I have
income earned from sources within the Philippines. My failure to do so will be considered a
breach of the terms and conditions of my loan with HSBC.
IN WITNESS THEREOF, I have hereunto set my hand this ___ day of __________ 200_.
Affiant (affix signature above printed name)
Republic of the Philippines )
City of __________ ) S.S.
SUBSCRIBED AND SWORN TO before me this ___ day of __________ 201__ affiant exhibiting
before me his/her Community Tax Certificate No. ____________________ issued on
___________________ at _____________________ and __________________________ I.D. issued on
_________________________ and will expire on _________________________.