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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF MASBATE )S.S


CITY OF MASBATE )
X--------------------------X

AFFIDAVIT OF TERMINATION OF BUSINESS

I, Alice Tudlasan Bernal, of legal age, Single and a resident of Sitio Taisan, Barangay
Calumpang, Milagros, Masbate after having been duly sworn in accordance with law do hereby
depose and state:

1. That I am the registered owner of the business name DMX Xyber Café with
the Bureau of Internal Revenue (BIR) under TIN No. 289-303-992-000;

2. That I am applying for the termination/closure of the business name, DMX


Xyber Café, registered with the BIR under TIN No. 289-303-992-000;

3. That the reason for the termination is due to the fact that DMX Xyber Café
ceased to operate since 2014 but I was not able to request for termination of
the business with the BIR at an earlier date;

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

5. That I am executing this affidavit to attest to the truth of all the foregoing
statement and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of


___________________, 2018 at Masbate City, Philippines.

ALICE T. BERNAL
Affiant
CTC No: __________
Issued on: _________
At: _______________

SUBSCRIBED AND SWORN to before me this ______ day of ___________________, 2018 in


Masbate City, Philippines, by affiant, known to me to be the same person who executed and
personally signed the foregoing document before me and avowed under penalty of law to the
whole truth of the contents hereof.

__________________________
Subscribing Officer

Doc. No. _______;


Page No. _______;
Book No. _______;
Series of 2018
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF MASBATE )S.S
CITY OF MASBATE )
X--------------------------X

AFFIDAVIT OF LOSS

I, Alice Tudlasan Bernal, of legal age, Single and a resident of Sitio Taisan, Barangay
Calumpang, Milagros, Masbate after having been duly sworn in accordance with law do hereby
depose and state:

1. I am holder/owner/ or possessor of the business name certificate of DMX Xyber


Café or Original Certificate of Registration, the duplicate copy of its application
form, books of accounts and unused Official Receipts;

2. I have recently discovered the said items are irretrievably lost and can no longer
be found despite diligent efforts to locate the same;

3. I execute this affidavit to attest to the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of


___________________, 2018 at Masbate City, Philippines.

ALICE T. BERNAL
Affiant
CTC No: __________
Issued on: _________
At: _______________

SUBSCRIBED AND SWORN to before me this ______ day of ___________________, 2018 in


Masbate City, Philippines, by affiant, known to me to be the same person who executed and
personally signed the foregoing document before me and avowed under penalty of law to the
whole truth of the contents hereof.

__________________________
Subscribing Officer

Doc. No. _______;


Page No. _______;
Book No. _______;
Series of 2018
January 25, 2018

Bureau of Internal Revenue


Revenue District Office No. 70
Masbate City, Masbate

To whom it may concern,

This is to request your good office for the closure/termination of the business name DMX
Xyber Café registered under my name, Alice T. Bernal, with TIN No. 289-303-992-000 due to
the fact that the business ceased its operation since year 2014. My affidavit for termination of
business is hereto attached as “Annex A”.

It has recently come to my attention that it is recorded as an open case in your tax system
due to my failure to request for its closure/termination at an earlier date. I also understand that
penalty shall be continuously imposed on my TIN No. 289-303-992-000 until the business name
DMX Xyber Café is officially closed/terminated and that my inadvertence resulted to accrued
penalties. Please be assured that I will settle any and all amounts due to the BIR.

Furthermore, the business name certificate of DMX Xyber Café and other pertinent
documents relative to the closure/termination of the business can no longer be found despite my
diligent efforts to locate it, resulting from the passage of time. My affidavit of loss is hereto
attached as “Annex B” to support the same.

In view of this, I respectfully request for the closure/termination of the business name
DMX Xyber Café registered under my name with TIN No. 289-303-992-000.

Thank you for your attention to this matter.

Sincerely,

ALICE T. BERNAL
CP No. 09500094133