Republic of the Philippines)

____________________) S.S

AFFIDAVIT OF FACTS

KNOW ALL MEN BY THESE PRESENTS:

I, _______________________of legal age , Filipino, married and a resident of

_____________________________________, after having been sworn in accordance with law, hereby
deposes and states the following:

1. That I am the Owner / Proprietress of __________________________ with business address

___________________________________________;

2. That the said Business Name registered to Department of Trade & Industry on June 5, 2015 to
June 5, 2020;

3. That I forgot to renew my Business Name to Department of Trade & Industry;

4. That for the reason that time was pandemic;

5. That I am requesting consideration from the DTI to use the business name La Casa Elma again;

6. That I am executing this affidavit to attest to the truth of the foregoing statement to inform the
proper authorities concerned and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 TH day of MAY, 2021 in MANILA.

_________________
AFFIANT

SUBSCRIBED and SWORN to before me this 28TH day of MAY 2021 at MANILA affiant
exhibiting his/her CTC No. ____________________ issued at ______________________ on
___________________________.

NOTARY PUBLIC

Doc. No. __________

Page No. __________
Book No. __________
Series of 2021