REPUBLIC OF THE PHILIPPINES)

CALAMBA CITY ) S.S.

AFFIDAVIT OF CANCELLATION
WITH NO FINANCIAL OBLIGATION

I, JOANNE A. REFREA, of legal age, single, Filipino, and with residence

address at UPLB Pili Drive, Batong Malake, Los Baňos, Laguna after having been duly
sworn to in accordance with law, hereby depose and state that:

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

MEDICAL AND LABORATORY SUPPLY located at No. 175 Brgy. Real, Calamba
City;

2. The above stated business was duly registered at the Department of Trade
and Industry (DTI) on 27 May 2021 and was issued Certificate of Registration
No.2942692;

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

due to change of business organization from sole proprietorship to corporation;

4. As far as my personal knowledge as the registered owner, I attest to the

fact that DIEM MEDICAL AND LABORATORY SUPPLY has no outstanding financial
obligation to any individual, public or private corporations or entities;

5. I further declare that the cancellation is not intended to defraud creditors

and that I, as registered owner has no outstanding or pending financial obligation in
connection with the said business;

6. That I am executing this Affidavit to attest the attest the truthfulness of

the foregoing declarations under penalties of perjury to respectfully request the DTI to
CANCEL Certificate of Registration No. 2942692, and for other legal purposes it may
serve;

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________________ 2022 in the City of Calamba, Laguna, Philippines.

JOANNE A. REFREA
Affiant

SUBSCRIBED AND SWORN to before me this ____________________ 2022

at Calamba City. Affiant exhibiting to me her PRC No. 0603533 as her evidence of identity

Doc. No.: __________;

Book No.: __________;
Page No.: __________;
Series of 2022