eAccReg Sworn Statement - Taxpayer

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August ,4 2019

Date

___Revenue Region N0.005/RDO027___


Caloocan City

SIR/Ma’am:

This is to inform your office that Mr./Ms. Jayson F. Panganiban is the company’s authorized user of
the esales System for the Katitay’s Takoyaki Food cart, SM Sangadaan Supermarket Caloocan. with TIN
(including Branch Code): 141-312-934-006, SM Supermarket, SM Sangadaan, Caloocan City. Below are
his/her information:

TIN : 267-165-763
USERNAME : Jayson F. Panganiban
FIRST NAME : Jayson
MIDDLE NAME : Flaviano
LAST NAME : Panganiban
EMAIL ADDRESS : jayson.panganiban18@gmail.com

Very truly yours,

_________________________
(Signature Over Printed Name)

KATITAY’S TAKOYAKI FOOD CART


Name of Company
141-312-934-006
TIN
Sm Sangadaan Supermarket, Brgy, 003
District 1, Caloocan City
Address
046-4093973
Telephone Number

SUBSCRIBED AND SWORN to before me, this ____ day of __________, 20___, at ____________,
affiant exhibiting to me his/her Community Tax Certificate, as follows:

Name CTC Number Date of Issue Place of Issue

Notary Public

Doc. No. _____


Page No. _____
Book No. _____
Series of 20____

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