Additional Disclosure To Fs For Non Profit, Non Stock
Additional Disclosure To Fs For Non Profit, Non Stock
NSPO Form-1
SWORN STATEMENT
We ____________________________and _________________________, President and
Treasurer, respectively of _______________________________, with address
at___________________________________________________________hereby depose and
state that:
In compliance with SRC Rule 68, as amended, we are stating the following information that
related to the preceding fiscal year_______________, to wit:
Check if
Documents/ Schedules to the NSPO Forms applicable
Audited Financial Statements as of
________________
1. Affidavit of Willingness to be Audited by the Commission NSPO Form-2
2. Schedule of Receipts or Income or Sources of Funds Other NSPO Form-3
Than Contributions and Donations
3. Schedule of Contributions and Donations NSPO Form-4
4. Schedule of Application of Funds NSPO Form-5
5. Certificate of Existence of Program/Activity (COEP)
6. COEP issued by Heads/Officersof private institution or actual
beneficiaries/recipients of the program/activity shall be
allowed in lieu of COEP issued by the government
offices/entities
We hereby certify that this Sworn Statement with duly attached documents/schedules is executed
to attest to the truth of the foregoing and for whatever legal purpose it may serve.
In witness thereof, we have hereunto affixed our signature this ______ day of _______2013,
at_________________, Philippines.
________________ _______________
President Treasurer
Subscribed and sworn to before me, a Notary Public for and In _____________________ City, on
_________affiants personally, exhibiting their respective competent evidence of Identification
Card_______ issued at__________ issued on ____________________________.
NOTARY PUBLIC
Doc. No.
Page No.
Book No.
Series of
NSPO Form-2
REPUBLIC OF THE PHILIPPINES)
) S.S.
NSPO Form-4
Page 1 of 2
SCHEDULE OF CONTRIBUTIONS AND DONATIONS (PART I)
Name of Foundation/Organization SEC Registration No.
Page 2 of 2
SCHEDULE OF CONTRIBUTIONS AND DONATIONS (PART II)
Name of Foundation/Organization SEC Registration No.
For the year ended
Part II Noncash Property
(a) (b) (c) (d)
No. Description of noncash property given Fair Market Date received
from
Part Value (or
I estimate)
1 P
2 P
3 P
4 P
5 P
6 P
7 P
8 P
9 P
10 P
(Use separate sheet if necessary)
NSPO Form-5
Page 1 of 1
SCHEDULE OF APPLICATION OF FUNDS
Name of Foundation/Organization SEC Registration No.
NSPO Form-6
I, ____________________, of legal age, single/married, Filipino citizen, with residence address at
_____________________________________________________________, after having been sworn to in
accordance with law, do hereby depose and state that:
2. The Foundation has not received any funds form any Philippine government agency or any
department, bureau or office of the national government, or any of its branches and
instrumentalities, or any political subdivision, or its instrumentalities, as well as any government
-owned or controlled corporation, including its subsidiaries, or other self-governing board or
commission of the government, nor received donations/grants/contributions in the amount of at
least Five Hundred Thousand Pesos (Php500,000) in one or aggregate transactions per
donor/grantor/contributor; and
3. To the best of my knowledge, no action or proceeding has been filed or pending before any court
involving an intra-corporate dispute and/or claim by any person or group against the Foundation,
its duly elected Trustees and/or corporate officers.
IN WITNESS WHEREOF, I have hereunto signed this Certification this _ day of _________ at
______________.