Annex “F”
SWORN DECLARATION AND WAIVER
OF RIGHT
TO CLAIM EXEMPTIONS OF
QUALIFIED DEPENDENT CHILDREN
In accordance with the provisions of Section
29 (1) (2) (A) of the National Internal Revenue Code, as amended, I Mr.
_________________________________________________, hereby voluntarily depose
and say:
1.
That my
wife and I are both income earners;
2.
That we
file a joint income tax return on our taxable income;
3.
That I
am a (check pls): ___ self employed: ___ engaged in business; ___ practice
profession;
4.
That
this waiver will be effective for the taxable year _______ and shall continue
for the succeeding years unless sooner revoked;
5.
That I
hereby waive my right to claim the additional exemption for all our qualified
dependent children in favor of my wife presently employed with:
Name of wife:
___________________________________________________________________________________
Name of wife’s employer
__________________________________________________________________________
Address of employer ______________________________________________________________________________
TIN of employer ________________________ Tel No. _____________________
Fax No. ______________________
|
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Name
of qualified dependent child(ren)
|
Date
of Birth (mm/dd/yyy)
|
|
1
|
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2
|
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3
|
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4
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I hereby declared under penalties of perjury that the
foregoing representations are true and correct and that the waiver of right is
voluntarily and knowingly ma de in
accordance with the provisions of the National Internal Revenue Code, as
amended.
_________________________________ ____________________ _______________________
(Signature of husband over printed name) TIN Date
________________________________________________________________________________________________
ACKNOWLEDGEMENT OF HUSBAND’S
EMPLOYER
|
Name of husband’s
employer________________________________________________________________________
Address of employer ______________________________________________________________________________
TIN of employer________________________ Tel No.
__________________ Fax No. _________________________
|
____________________________________________ ___________________________
(Signature over printed name of husband’s employer/ Date (mm/dd/yyy)
Chief
Accountant/Head, Personnel Office)
________________________________________________________________________________________________
ACKNOWLEDGEMENT OF WIFE’S
EMPLOYER
This is to acknowledge receipt of the above waiver of
right to claim additional exemptions of Mr.
_______________________________________________________ in favor of his wife
Mrs/Ms. _____________________________________________ who shall be entitled to claim
the additional exemptions for all their qualified dependent children effective
______________________ ________________.
(Month) (taxable year)
|
Name of wife’s employer
___________________________________________________________________________
Address of employer
______________________________________________________________________________
TIN of employer _______________ Tel No.____________
Fax No.______________
|
_________________________________________ ___________________________
(Signature over printed name of wife’s employer/ Date (mm/dd/yyy)
Chief
Accountant/Head, Personnel Office)
Note: If
husband engaged in business, disregard the portion on Acknowledgement of Husband’s
Employer.
Must be signed by both employers of husband
and wife before effecting changes in the payroll of their respective employers.
Must
be attached to BIR Form No. 2305 or BIR Form No. 1902.
