Republic of the Philippines )

Cainta, Rizal )S.S.

AFFIDAVIT OF CANCELLATION

I, _______________, of legal age, married, and a resident of _______________, under

oath do hereby depose and state, that:

I am the owner of a business under the name _______________ with business address
at _______________;

Aforesaid business was registered with the Department of Trade and Industry with
Certificate No. _______________;

I am now causing the cancellation of my business with the Department of Trade and
Industry for the reason that my aforesaid business did not operate since the time of its
registration;

My business had no creditors or liabilities with anyone at the time of cancellation of said
business;

I am executing this affidavit to attest to the veracity of the foregoing statement for
purposes not contrary to law, morals, good custom and public policy.

IN WITNESS WHEREOF, I have hereunto set my hand and signature this 16 th day of May
2016 at _______________.

_______________
Affiant

SUBSCRIBED AND SWORN TO before me on the date and at the place above written.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2016.