REPUBLIC OF THE PHILIPPINES)

CITY OF OLONGAPO ) S.S.

AFFIDAVIT OF CANCELLATION WITH NO FINANCIAL OBLIGATION

I, _______________, of legal age, (marital status), (citizenship), and resident of ______________________,

after having been sworn in accordance with law hereby depose and state:

1. That I am the registered owner of a business under the trade name ____________________ located at

________________________________________________;

2. That the above-said business was duly registered at the Department of Trade and Industry (DTI) on

______________ and was issued Certificate of Registration with No._____________;

3. That at present I am causing the cancellation due to ________________________________________ and

the execution of the foregoing affidavit is in support;

4. That as far as my personal knowledge as the registered owner, I attest to the fact that (BUSINESS NAME) ,

has no standing financial obligation to any individual public or private corporation or entities;

5. That I am executing this affidavit to attest the truthfulness of the foregoing declarations under penalties of

perjury to respectfully request the DTI to CANCEL the Certificate of Registration No.___________.,

moreover to serve all legal intents.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby affix my signature on this ___ day of _________, ________ at Olongapo City,
Philippines.

AFFIANT:

_______________
Registered Owner
SUBSCRIBED AND SWORN to before me this ___ day of __________, _______ in the City of Olongapo by
(NAME OF AFFIANT) with _____________________________________ issued on ____________; valid until
_______________.

NOTARY PUBLIC

Doc. No. _______

Page No. _______
Book No. _______
Series of 2019