AFFIDAVIT OF CANCELLATION

I, _________________________, Filipino citizen, of legal age, single/married,

with residence/office address at _______________________________, after having
been sworn to in accordance with law, hereby depose and say, that :
1. I am currently the registered owner of ______________________, whose
business is registered with the Department of Trade and Industry (DTI),
evidenced by DTI No. ________________, issued on ______________, with
office address at _________________________;
2. On ______________, due to ________________, I transferred ownership of the
business to _________________, Filipino citizen, of legal age, single/married,
with residence at _________________________________, who intends to
register the business under a different name.;
3. As a registered owner of ________________, I have no outstanding creditors at
the time of closure of business.
4. I am executing this Affidavit as a requirement for the voluntary cancellation of
registered business name and for whatever legal purpose and intent it may
serve.
IN WITNESS HEREOF, I have hereunto signed my name below this ______ day
of ________________, 2012 at Makati City, Philippines.
_________________________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this ________ day of
____________________, ___________ in __________________________________,
affiant exhibiting to me his/her Government Issued Identification Nos. ______________
and _________________.

Doc. No.
__________
Page No.
__________
Book No.
__________
Series of 2012.
Notary Public