REPUBLIC OF THE PHILIPPINES)

_____________________________ ) S.S.

AFFIDAVIT
RE: TERMINATION OF BUSINESS

I, (Name), of legal age, (marital status) and a resident of (address), after having been duly sworn in
accordance with law do hereby depose and state:
That I am the (designation) of the business name (Name of Business) which is registered with the
Bureau of Internal Revenue (BIR);
That I am applying for the termination of the business, (Name of Business), registered with the BIR
in (date of registration), with Certificate of Registration OCN No. (certificate number), which I decided to
close effective (effectively date of closure);
That the reason for the termination is due to (state reason for closing the business);
That the business has no outstanding liability and obligation;
That I am executing this affidavit to attest to the truth of all the foregoing statements and for whatever
legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _________________ at _____________,

Philippines.

Printed Name and Signature

Affiant
CTC No: ______________
Issued on: _____________
At: ___________________

SUBSCRIBED AND SWORN to before me this __th day of _______________ at ____________,

Philippines.

Doc. No. : ________;

Page No. : ________;
Book No. : ________;
Series of 20___.