Republic of the Philippines

)
Bacoor, Cavite
) s.s.

AFFIDAVIT OF CLOSURE
I, <NAME>, of legal age, Filipino citizen, with residence at { address
}, depose and state, THAT 1. I am the registered proprietor of a business under the name and
style of { Name of Business }
2. The business name was registered by me in June 2005 and was
issued a certificate of business name registration by the Department
of Trade and Industry which registration expires on June 2012;
3. Due to difficulty in securing contracts to undertake, I have
decided to close the business ;
4. I declare and affirm that
as at the time of closure of
establishment, the registered business has no outstanding financial
obligation ;
5. Attached hereto is the original copy of the Business Name
certificate and the duplicate copy of the application form filed with
the Department of Trade and Industry which i am submitting for
cancellation.
In Witness Whereof, I have hereunto set my hand this 26th day of
April, 2012.

< Name >

Affiant
SUBSCRIBED AND SWORN TO Before Me this
day of April, 2012.
Affiant exhibiting to me her Driver's License bearing number
and to expire on
as competent means of
identification.

Notary Public
Doc. No.
Page No.
Book No.

Series of 2012.