REPUBLIC OF THE PHILIPPINES )

Province of Iloilo ) S.S.

City/ Municipality of ____________)
X - - - - - - - - - -- - - -- - - - - - - - - - - - - - - X

AFFIDAVIT
RE: TERMINATION OF BUSINESS

I, RANDE M. GONZAGA of legal age, married and a resident of Brgy. Daja,

Maasin, Iloilo, after having been duly sworn in accordance with law do hereby
depose and state:

1. That I am the proprietor/owner of the business name RANDE DRESSED

CHICKEN which is registered with the Bureau of Internal Revenue (BIR);

2. That I am applying for the termination of the business, RANDE DRESSED

CHICKEN, registered with the BIR in 25 July 2016 with Certificate of
Registration OCN No. 2RC0001050586, which I decided to close
effective January 1, 2019;

3. That I am executing this Affidavit of CLOSURE in my said capacity;

4. That I am formally terminating my business due to financial problems

and difficulty to generate funds to sustain the business;

5. That the business has no outstanding liability and obligation;

6. That I am executing this affidavit to attest to the truth of all the

foregoing statements and for whatever legal purpose it may serve with
regard to the closure of the business.

IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day of January

2019 at ________________________, Philippines.

RANDE M. GONZAGA
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

Province of Iloilo this _____th day of ____________________ 2019. Affiant personally
came and appeared with Taxpayer Identification Card with No. 487-664-571
bearing his photograph and signature, known to me as the same person who
personally signed the foregoing instrument before me and avowed under penalty
of law to the whole truth of the contents of said instrument.

Doc. No. : ________;

Page No. : ________;
Book No. : ________;
Series of 2019.