REPUBLIC OF THE PHILIPPINES)

QUEZON CITY, METRO MANILA) S.S

AFFIDAVIT OF BUSINESS CLOSURE/ RETIREMENT

I, _________________, of legal age, and a resident of

____________________________________________________, and in my capacity as Owner
of __________________, after having been duly sworn to in accordance with law, hereby
depose and say, that:

1. That I am the owner of ___________________, with business address at

____________________________________________;
2. That the company has stopped its business operation since __________________ due
to ____________________________;
3. I am executing this affidavit to attest the veracity of my statements and for the
purpose of applying for full retirement and business closure of the company with the
Cityhall, BIR, and other related government agencies.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of January 2021 in the
City of _____________. Philippines.

__________________
Owner

SUBSCRIBED AND SWORN to before me this ____ day of _____ 2021 at

____________, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2021_