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    Affidavit of Income Declaration

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    Grasya Albano
    This document is an affidavit from an individual declaring their income for the purpose of registering as a self-employed member of PhilHealth. It states that the individual has been earning income since 2012 as a part-time online English teacher, paid $100 per hour through PayPal each month. On average, they receive $5,000 monthly income from this work. The affidavit is being provided to attest to the truth of these details regarding their application for PhilHealth registration.

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    Affidavit of Income Declaration

    Uploaded by

    Grasya Albano
    998 views1 page
    This document is an affidavit from an individual declaring their income for the purpose of registering as a self-employed member of PhilHealth. It states that the individual has been earning income since 2012 as a part-time online English teacher, paid $100 per hour through PayPal each month. On average, they receive $5,000 monthly income from this work. The affidavit is being provided to attest to the truth of these details regarding their application for PhilHealth registration.

    Original Description:

    Declaring source and income.

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    This document is an affidavit from an individual declaring their income for the purpose of registering as a self-employed member of PhilHealth. It states that the individual has been earning income since 2012 as a part-time online English teacher, paid $100 per hour through PayPal each month. On average, they receive $5,000 monthly income from this work. The affidavit is being provided to attest to the truth of these details regarding their application for PhilHealth registration.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    998 views1 page

    Affidavit of Income Declaration

    Uploaded by

    Grasya Albano
    This document is an affidavit from an individual declaring their income for the purpose of registering as a self-employed member of PhilHealth. It states that the individual has been earning income since 2012 as a part-time online English teacher, paid $100 per hour through PayPal each month. On average, they receive $5,000 monthly income from this work. The affidavit is being provided to attest to the truth of these details regarding their application for PhilHealth registration.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    Republic of the Philippines )

    City of ____________ )s.s.


    x--------------------------/

    AFFIDAVIT
    (Income Declaration)

    I, ___________________, of legal age, Filipino, single/married, and


    a resident of ____________________________________, Philippines,
    after having been duly sworn to in accordance with law, do hereby depose and
    state: That -

    1.) I am earning income as a parttime English as a Second Language (ESL)


    online teacher since 2012;

    2.) I am paid at a rate of Php100 per hour and such payment is coursed
    through my paypal account every month by my students;

    3.) On average, I am receiving a monthly income of Php5,000.00;

    4.) I am voluntarily executing this affidavit to attest to the truth of the


    foregoing facts and to support my application for registration as a Self-
    Employed Member of the Philippine Health Insurance Corporation
    (PhilHealth).

    IN WITNESS WHEREOF, I have hereunto set my hand this


    ______________ in the City of ___________, Philippines.

    [name]
    Affiant
    Government issued ID No. __________;
    valid until ____________

    SUBSCRIBED AND SWORN to before me this


    _______________________ in the City of _______________,
    Philippines, affiant having exhibited to me her competent proof of identity
    indicated below her name.
    WITNESS MY HAND AND SEAL on the date and at the place above-
    written.

    Doc. No. _____;


    Page No. _____;
    Book No. _____;
    Series of 2020.

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