REPUBLIC OF THE PHILIPPINES )

CITY OF CABANATUAN )S.C.

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AFFIDAVIT OF BANKRUPTCY

I, CRISTINA D. DEL ROSARIO, of legal age, Filipino, married and a

resident of Barangay Vega, Bongabon, Nueva Ecija, after having been duly
sworn hereby depose and say:

1. That I am the registered owner of VIVIAN S. CUDIA ONION AND

PALAY DEALER situated at Vega, Bongabon, Nueva Ecija;

2. That I am closing the said business on June 27, 2016, due to change
trade name from VIVIAN S. CUDIA ONION AND PALAY DEALER to
VIVIAN S. CUDIA GENERAL MERCHANDIZED;

3. That I have no financial obligations to any supplier or creditor during the

course of my operation of the said business;

4. That I am requesting to the DEPARTMENT OF TRADE AND

INDUSTRY to cause the cancellation of my business name registration;

5. That this affidavit has been executed to attest to the truth of all the
foregoing facts and for whatever legal intents and purposes this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of

June, 2016, hereat Cabanatuan City, Nueva Ecija.

VIVIAN S. CUDIA
Affiant
CEI-TIN. 215-209-055

SUBSCRIBED AND SWORN to before me, this 27th day of June, 2016,
hereat Cabanatuan City, Nueva Ecija.

Doc. No. __________;

Pages No._________;
Book No.__________;
Series of 2016.