REPUBLIC OF THE PHILIPPINES )

PROVINCE OF )
MUNICIPALITY/CITY OF ) S.S

AFFIDAVIT OF CLOSURE

I, ________________, of legal age, single/married, Filipino citizen and a resident of

___________________, after having been duly sworn in accordance with law do hereby depose
and state:

1. That I am the registered owner of a certain business establishment bearing the business
name ________________ located at ________________;

2. That I had the intention to close the aforementioned establishment and in fact have
already been closed since _____________ as it is no longer a profit-making business;

3. That the closure is permanent in nature and I have no intention to re-open the same in the
future

4. That the gross income for the last year duration of operation was ___________ PESOS
(Php _____________)

5. That I am executing this affidavit as proof of closure of the aforementioned business for
all legal purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of _____ 2022
Laoag City, Ilocos Norte, Philippines.

______________________________
(Affiant)
(ID No._______________)

SUBSCRIBED AND SWORN to before me, in the city/municipality of __________, this

_________ day of 2022 by ___________ with (ID and ID number) issued at _____ on ______
2022.

Doc No.
Page No.
Book No.
Series of 2022