Republic of the Philippines]

City of Malaybalay] s.s

AFFIDAVIT OF CANCELLATION/CLOSURE OF BUSINESS NAME

I, ____________________________, of legal age, Filipino citizen, married, with resident address

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

1. I am the named owner of __________________ located at _____________________________

with Certificate No__________ registered before the Department of Trade and Industry;
2. I have not commenced operation under the said name and opted to relinquish the same and for
some reason I would like to apply for the cancellation of said business name;
3. My business if free from liens and encumbrances and we have no creditors because we have not
commenced operation using the said business name;
4. I am executing this affidavit for the purpose of cancellation/closure of business name;
5. I attest to the truthfulness of this affidavit.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of June 2022, at
_____________________________, Philippines.