REPUBLIC OF THE PHILIPPINES )

CITY OF TARLAC ) S.S.

PROVINCE OF TARLAC )

AFFIDAVIT OF CANCELLATION
That I, DWIGHT Y. MACABUHAY, of legal age, Filipino, married to Karen Rose Macabuhay,
resident of and with postal address at Sinilian 3rd, Camiling, Tarlac after having been duly sworn to in
accordance with law, depose and say that:

1. I am a registered owner of a business under the trade name Macbelly’s Art Cafe located at
2nd Floor Sotero Building, Burgos St., Pob. B., Camiling, Tarlac;

2. The above-stated business was duly registered at the Department of Trade and Industry (DTI)
on ______________ and was issued Certificate of Registration with No. ______________;

3. At present, I am causing the cancellation of the said registered business due bankruptcy;

4. The cancellation is not intended to defraud my creditors and that I have no outstanding and
pending financial obligation with my business or that I had notified all my creditors of such
cancellation, as the case maybe;

5. I am executing this affidavit to the attest the truthfulness of the foregoing declarations under
penalties of perjury to respectfully request the DTI to CANCEL Certificate of Registration
No. ______________, and for other legal purposes.

IN WITNESS WHEREOF, we have hereunto set our hand this _______________ at Tarlac City.

DWIGHT Y. MACABUHAY
Affiant
Passport No.: EC8080303

SIGNED IN THE PRESENCE OF:

_______________________ _______________________

BEFORE ME, at the locality and date above-mentioned came and personally appeared the above-
named party with their Competent Evidence of Identity, known to be the same person who executed the
foregoing instrument and acknowledge to me that the same is his/her own free and voluntary act and
deed.

WITNESS MY HAND AND SEAL

Doc. No._______;
Page No._______;
Book No._______;
Series of 2019.