Republic of the Philippines)

Province of Camarines Sur) S. S.

Municipality of Tigaon)
AFFIDAVIT OF CESSATION OF BUSINESS AND NO EARNINGS
I, ELMA I. BANTAL, Filipino, 60years old, married, and with residence and postal address
at, Gomez, Tigaon, Camarines Sur, after being duly sworn to in accordance with law, hereby
depose andstate:
1. That I am a self-employed member of the Social Security System (SSS) since 1998 being a
sole proprietor of a sari-sari store located at Gomez St., Tigaon, Camarines Sur;
2. On January 4, 2013, however, I already ceased and stopped operating my sari-sari store,
thus since then I earned no income from the same and from whatever source;
3. That since I have already ceased the operation of my business, I am informing the Social
Security System (SSS) by virtue of this Affidavit that I am abdicating and surrendering my
privilege to engage in the sari-sari store business;
4. As such, I am executing this Affidavit to attest to the truth of the foregoing facts, for the
purpose of informing the Social Security System (SSS) that I have ceased operating my sari-sari
store business since January 4, 2013 and that I have no income since then up to the present and
for whatever other legal purpose/s it may serve.
Further affiant sayeth naught.
IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of Janauary 2014 at
Tigaon, Camarines Sur, Philippines.
ELMA I. BANTAL
Affiant
SUBSCRIBED AND SWORN to before me, this 10 thday of January 2014 byElma I.
Bantal,who
exhibited
to
me
her
Identification
Document
bearing
No.
_____________________________ issued at _______________________, Philippineson
________________.