Annex
“E”
__________________________________________
(Name of Company)
________________________
(Date)
CERTIFICATE OF GROSS INCOME FOR THE YEAR
This is to certify that Mr./Ms./Mrs _______________________________
received the amount of
_______________________________________ (P ) as compensation income for the
period _________________________ from this company/enterprise, broken down as
follows:
_________________________________________________________
_________________________________________________________
_________________________________________________________
I declare, under the penalties of perjury, that the above informa tion are verified by me, and to the best of my
knowledge true and correct.
____________________________________________
(Employer’s Authorized Representative
& Designation)
