REPUBLIC OF THE PHILIPPINES)

_____________________________ ) S.S.
AFFIDAVIT
RE: TERMINATION OF BUSINESS
I, (Name), of legal age, (marital stats) a!" a resi"e!t of (a""ress), after #a$i!g %ee! "l& s'or! i!
a((or"a!(e 'it# la' "o #ere%& "e)ose a!" state*
T#at I am t#e ("esig!atio!) of t#e %si!ess !ame (Name of Bsi!ess) '#i(# is registere" 'it# t#e
Brea of I!ter!al Re$e!e (BIR)+
T#at I am a))l&i!g for t#e termi!atio! of t#e %si!ess, (Name of Bsi!ess), registere" 'it# t#e BIR
i! ("ate of registratio!), 'it# Certifi(ate of Registratio! OCN No. ((ertifi(ate !m%er), '#i(# I "e(i"e" to
(lose effe(ti$e (effe(ti$el& "ate of (losre)+
T#at t#e reaso! for t#e termi!atio! is "e to (state reaso! for (losi!g t#e %si!ess)+
T#at t#e %si!ess #as !o otsta!"i!g lia%ilit& a!" o%ligatio!+
T#at I am e,e(ti!g t#is affi"a$it to attest to t#e trt# of all t#e foregoi!g stateme!ts a!" for '#ate$er
legal )r)ose it ma& ser$e.
IN WITNESS WHEREOF, I #a$e #ere!to set m& #a!" t#is _________________ at _____________,
P#ili))i!es.
Pri!te" Name a!" Sig!atre
-ffia!t
CTC No* ______________
Isse" o!* _____________
-t* ___________________
SUBSCRIBED AND SWORN to %efore me t#is __t# "a& of _______________ at ____________,
P#ili))i!es.


.o(. No. * ________+
Page No. * ________+
Boo/ No. * ________+
Series of 01___.