Annexes 68-A PDF

Preview

Summary

NSPO Form-Page 1 of1SWORN STATEMENTWe, Macario Pagtalunan and Victoria D. Gozun, President andTreasurer, respectively of Jesus Touching Lives Church International Inc.,with addressat___________________________________________________________herebydepose and state that:In compliance with SRC Rule 68,...

Description

NSPO Form-1 Page 1 of 1

SWORN STATEMENT We, Macario Pagtalunan and Victoria D. Gozun, President and Treasurer, respectively of Jesus Touching Lives Church International Inc., 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:

Documents/ Schedules to the Audited Financial Statements as of ________________ 1. Affidavit of Willingness to be Audited by the Commission 2. Schedule of Receipts or Income or Sources of Funds Other Than Contributions and Donations 3. Schedule of Contributions and Donations 4. Schedule of Application of Funds

NSPO Forms

Check if applica ble

NSPO Form-2 NSPO Form-3 NSPO Form-4 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 Page 1 of 7

respective competent evidence of Identification Card_______ issued at__________ issued on ____________________________. NOTARY PUBLIC Doc. No. Page No. Book No. Series of

NSPO Form-2 Page 1 of 1

REPUBLIC OF THE PHILIPPINES) ) S.S. AFFIDAVIT OF WILLINGNESS TO BE AUDITED BY THE COMMISSION I, _________________, of legal age, Filipino and resident of _______________, after having been sworn to in accordance with law hereby depose and state: I am the Chief Finance Officer of ______________________________, a non-stock nonprofit organization registered with the Securities and Exchange Commission.

That I, as authorized by the Board of Directors of the corporation, hereby manifest its willingness to be audited by the Commission upon its Order and Authority for the purpose of determining compliance of the corporation with existing laws and regulations. That this affidavit is executed to attest to the truth of the foregoing and for whatever legal purpose and intent it may serve. In witness whereof, I hereby sign this affidavit this ______day of ___________ 20____ at _______________.

_________________________________ Affiant (Signature over printed name)

SUBSCRIBED AND SWORN to before me this ________ , affiant exhibiting to me his ______________________issued on ______________at _______________ as competent evidence of identity.

Page 2 of 7

Doc. No. ______; Page No. ______; Book No. _____; Series of 20__.

NSPO Form-3 SCHEDULE OF RECEIPTS OR INCOME OR SOURCES OF FUNDS OTHER THAN CONTRIBUTIONS AND DONATIONS Name of Foundation/Organization SEC Registration No. For the year ended Receipts Or Income Or Sources Of Funds (a) No.

(b) Description of Income

(c) Source

(d) Amount (indicate by footnote if other than Philippine currency, then translate in this column)

1

P

2

P

3

P

4

P

5

P

6

P

7

P

8

P

9

P

(e) Date Received/ Period Covered

Page 3 of 7

P

Others (aggregate of all sources of income which are individually below P100,000.00) (Use separate sheet if necessary) 10

NSPO Form-4 Page 1 of 2

SCHEDULE OF CONTRIBUTIONS AND DONATIONS (PART I) Name of Foundation/Organization SEC Registration No. For the year ended Part I (a) No.

1

2

3

4

5

6

7

Contributors/Donors1 (b) Name and address

(c) Nationality2

(d) Total Contributions

P

P

P

P

P

P

P

(e) Type of Contribution3 ___Cash ___Noncash (Complete Part is a noncash contribution) ___Cash ___Noncash (Complete Part is a noncash contribution) ___Cash ___Noncash (Complete Part is a noncash contribution) ___Cash ___Noncash (Complete Part is a noncash contribution) ___Cash ___Noncash (Complete Part is a noncash contribution) ___Cash ___Noncash (Complete Part is a noncash contribution) ___Cash ___Noncash (Complete Part

II if there

II if there

II if there

II if there

II if there

II if there

II if there

1 A contributor or donor includes individuals, partnerships, corporations, associations, trusts and organizations. 2 If supranational organization, indicate place of principal office or domicile. 3 Contributions or donations reportable on the Schedule are contributions, donations, grants, bequests, devises, and gifts of money or property, amounting to P100,000.00 or more from each contributor or donor.

Page 4 of 7

8

P

9

P

10

Others (aggregate of all contributions which are individually below P100,000.00) – by nationality

is a noncash contribution) ___Cash ___Noncash (Complete Part II if there is a noncash contribution) ___Cash ___Noncash (Complete Part II if there is a noncash contribution) ___Cash ___Noncash (Complete Part II if there is a noncash contribution)

P

(Use separate sheet if necessary)

Page 2 of 2

SCHEDULE OF CONTRIBUTIONS AND DONATIONS (PART II) Name of Foundation/Organization

SEC Registration No.

For the year ended

Part II (a )

Noncash Property

(b) Description of noncash property given

(c) Fair Market Value (or estimate)

No. fro m Par tI 1

P

2

P

3

P

4

P

5

P

6

P

(d) Date received

Page 5 of 7

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. For the year ended

(a) Item Numb er 1

(b) Description of Programs/Projects/Activities Name of Program/ Project/Activity:_________________________________

(c) Status ___Accomplished ___On-going ___Planned

Complete Office Address:_________________________ _____________________________________________

Name of Program/ Project/Activity:_________________________________

Contact Number:_________________ ___Accomplished ___On-going ___Planned

Contact Number of Project Office:__________________ Name of Program/ Project/Activity:_________________________________ Complete Office Address:_________________________ _____________________________________________

Name:__________________________

Complete Address:________________ _______________________________

Complete Office Address:_________________________ _____________________________________________

3

Name:__________________________

Complete Address:________________ _______________________________

Contact Number of Project Office:__________________

2

(d) Project Officer-In-Charge

Contact Number:_________________ ___Accomplished ___On-going ___Planned

Name:__________________________

Complete Address:________________

Page 6 of 7

_______________________________ Contact Number of Project Office:__________________

4

Name of Program/ Project/Activity:_________________________________

Contact Number:_________________ ___Accomplished ___On-going ___Planned

Complete Office Address:_________________________ _____________________________________________

Complete Address:________________ _______________________________

Contact Number of Project Office:__________________

5

Name of Program/ Project/Activity:_________________________________ Complete Office Address:_________________________ _____________________________________________ Contact Number of Project Office:__________________

Name:__________________________

Contact Number:_________________ ___Accomplished ___On-going ___Planned

Name:__________________________

Complete Address:________________ _______________________________ Contact Number:_________________

(Use separate sheet if necessary)

Page 7 of 7...