Republic of the Philippines)

City of Davao )S.S.

AFFIDAVIT OF CANCELLATION
with NO FINANCIAL OBLIGATION

I, _______, of legal age, single, Filipino, and a resident of Davao City,

Philippines, after having been duly sworn to in accordance with law, do hereby
depose and state that:

1. I am the registered owner of a business under the trade name _____

located at _________City, Philippines;

2. The above-said business was duly registered at the Department of

Trade and Industry (DTI) on September 6, 2013, and was issued
Certificate of Registration with Number 123456;

3. At present, I am causing the cancellation in order to apply for another

business name that will more particularly describe the new concept of
my business of having a “videoke bar and grill” and the execution of
the foregoing affidavit is in support thereof;

4. To my personal knowledge as the registered owner, I attest to the fact

that ________, has no standing financial obligation to any individual,
public or private corporation or entities, in connection with my business;

5. I am executing this affidavit to attest to the truthfulness of the

foregoing declarations under penalties of perjury, to request the DTI
to CANCEL Certificate of Registration No. 123456, and for whatever
legal intents and purposes it may serve;

IN WITNESS HEREOF, I hereby affix my signature this 19 th day of

August 2015, in Davao City Philippines.

_____
Affiant
ID Type: SSS ID
ID No.: 09-2096628-2

SUBSCRIBED AND SWORN to before me this 19th day of August 2015, in Davao
City, Philippines; Affiant exhibiting to me her competent evidence of identity as
indicated above.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2015.