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Republic of the Philippines

Province of Leyte
Municipality of Palo

) s.s.
(Cancellation of Business Name Registration)

I, RAUL RODILLAS VILLOCERO, of legal age, Filipino, married, and a
resident of Brgy. Guindapunan, Palo, Leyte after having been duly sworn to in
accordance with law hereby depose and state:
1. That I am the owner/proprietor of ROSE LPG DEALER (Barangay)
registered with the Department of Trade and Industries;
2. That in connection therewith, I was issued a Certificate of Business Name
Registration with Certificate No. 03320194;
3. That my Business Name Registration was issued on August 29, 2014 and
is valid until August 29, 2019;
4. That however, my business suffered from losses and financial problems
last August 2014;
5. That thus, I was constrained to close said business on the same month;
6. That at the time of the closure of my business until to date, I did not incur
any obligation from any creditor;
7. That I am requesting for the cancellation of my Registered Business
Name due to financial problems;
8. That I declare under oath that the cancellation of my BN registration is
not to defraud creditors;
9. That I have no outstanding and pending financial obligation with any
That I am executing this affidavit to attest to the truth of the
foregoing statements, to support my request for the cancellation of my
business name registration and for whatever legal purpose this may
IN WITNESS WHEREOF, I have hereunto affixed my signature this 18th
day of November 2015 at Palo, Leyte.

ID No.: ___________________
Issued By: ________________
SUBSCRIBED and SWORN to before me this 18th day of November 2015
at Palo, Leyte.
Doc No.
Page No.

Book No. Series of 2015 .