REPUBLIC OF THE PHILIPPINES)

CITY OF ILOILO ) S.S.

x---------------------------x

AFFIDAVIT OF CLOSURE OF BUSINESS

I, _____________________, of legal age, married, Filipino, and a

resident of ___________________, Villa Juanita Subd., Brgy. Anilao,
Pavia, Iloilo after being duly sworn to in accordance with law, do hereby
depose and state;

1. That I am the owner/proprietor of _______________, a business

engaged in spa and massage parlor services located at
_________________________________;

2. That last _____________________ I decided to stop the

operation of the aforementioned business due to (stated reason/s);

3. That the business has no outstanding liability and obligations;

4. That I am executing this affidavit to establish the truthfulness of

the foregoing statements and for whatever legal purpose it may serve.

IN WITNESS OF THE FOREGOING, I have hereunto affixed my

signature this February __, 2021, in Iloilo City, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN TO before me this __ day of

__________ 2021, in Iloilo City, Philippines. Affiant has exhibited to me
her_________________________ as proof of identity as required by the
New Rules on Notarial Practice.

Doc. No. ___

Page No. ___
Book No. ___
Series of 2021.