Republic of the Philippines )

City of Cebu…………………….) S.S.

AFFIDAVIT OF NON-FILING OF INCOME TAX RETURN

I, RICARDO S. DALISAY, of legal age, Filipino, married, and a resident of Sitio

Mangga Punta Princesa, Cebu City, Philippines having been duly sworn in accordance
with law, hereby depose and state:

1. That I am the biological father of RICARDO A. DALISAY, JR.;

2. That RICARDO A. DALISAY, JR.; is currently enrolled as Grade 10 student

at University of San Jose-Recoletos Basak Campus;

3. That my son is applying in a Scholarship Program under the Senior High

School Voucher Program for SY 2017-2018;

4. That one of the requirements is a proof of the Bureau of Internal Revenue

(BIR) validated Income Tax Return (ITR) of parents;

5. That I did not file my ITR in the BIR because my annual income does not
exceed sixty thousand pesos (Php. 60,000.00) my job being a jeepney driver
where my sales income are usually fluctuating;

6. That I am executing this affidavit to attest to the veracity of the foregoing

facts, in support of my son’s application for scholarship and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 5 th day of

February 2017, in Cebu City, Philippines.

RICARDO S. DALISAY
Affiant
SSS ID. No. 10168405180
Issued at: Cebu City

SUBSCRIBED AND SWORN to before me this 5th day of February 2017 at Cebu
City, Philippines. Affiant exhibited to me his competent evidence of identity as per data
indicated below his name.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2017.