REPUBLIC OF THE PHILIPPINES)

PANABO CITY…………………..) S.S.

AFFIDAVIT

RE: CANCELLATION OF BUSINESS NAME

I, Annie Rose O. Arcenal, of legal age, Single and a resident of 6477 Arguilles St, San Francisco
(Pob.) Panabo City Davao Del Norte 8105, after having been duly sworn in accordance with law do
hereby depose and state:

That I am the OWNER of the business name ARCENAL BUILDING which is registered with the
Department of Trade and Industry (DTI).

That I am applying for the cancellation of the business name, ARCENAL BUILDING, registered in
February 2, 2018, with Certificate No. 05184203, which I decided to cancel effective today June 27,
2018;

That the reason for the cancellation is due to NEW OWNERSHIP OF 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 27th June 2018 at Panabo City, Philippines.

Annie Rose O. Arcenal

Affiant
CTC No: 20360331
Issued on: 01-08-2018
At: San Francisco, Panabo City

SUBSCRIBED AND SWORN to before me this at , Philippines.

Doc. No. : ________;

Page No. : ________;

Book No. : ________;

Series of 20___.