Republic of the Philippines CITY OF CALAMBA Business Permits and Tricycle Franchising Office BUSINESS RETIREMENT Pursuant to the provisions of Resolution No. 204 Series of 2006 (Ordinance No. 371-2006, Section 2E) City of Calamba. | am hereby applying for the retirement and submitting the following gross sales/receipts of my business/es: Name of Business Nature of Business BIN: Permit No. Location: — Payment details — ‘ORNo. ‘| Dated: ORNo. Dated: ‘ORNo. Dated: OR No. Dated: Reason for Retirement: Previous Years Gross Sales/Receipts: Php_ Php. Php. Php_ Php. Php. Current Year Gross Sales/Receipts: January Php. July Php. February Php. August Ppa aha at March Php. September Php. April Php_ October Php_ ‘May Php. November Php_ June Php. December Php. Total CY Gross Sales/ReceiptsPhp_ REMARKS: Ticensé Inspector ‘Owner/Representative (inate over printed ao) (Signature over printed name) ‘Approved by: IBARRA FRANCISCO G. ENCARNACION BPTFO, Department Head Requirements for Business Retirement BIR Stamped Audited Financial Statement Original Business Tax Receipts Board Resolution/Secretary’s Certificate Certificate of Non-Operation in case of no sales/operation from the Barangay Captain where the business is located Original Mayor's Permit/License for the current year Authorization of Representative with two photocopies of LD. 000000 Only Application w/ complete documents will be processed Note: The mere fling of this application does not automatically relieve the applicant of any tax lability. He/she shall submit his/her books of accounts for verification/validation.1, .of legal age married/single, Filipino and resident of after having been duly sworn to in accordance with law, do hereby depose and state that: 11am the owner/General Manager/President/Duly Authorized Representative of swith business address at 2. The businessoperation of my establishment/our company has ceased/stopped effective __due to 3. 1/We shall no longer use the said business name, operation and business address or transfer/change the same to other owner/s or company wherein I/we will have interest or shares therein; 4, My/Our application for retirement/cancellation of business or businesses is legitimate and in accordance with the provisions of Section 145 of R.A. 7160, otherwise known as the Local Government Code of 1991; 5. The retirement of my/our business/es is not intended to avoid or evade the payment of local taxes, fees and charges and that !/We hereby declare under oath that the retirement thereof is not simulated or in bad faith; 6. 1/We fully understood that any untruthful allegations contained herein shall make me/us liable for perjury and that criminal civil and administrative charges can be filed against me/us by the City Treasurer of Calamba; 7. We have executed this affidavit to attest the truthfulness of all the foregoing facts and circumstances to prove that the retirement/cancellation of my/our business is legal and in accordance with law, rules and regulations; IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this _______day of __ in the City of Calamba Affiant ‘Afiant SUBSCRIBED AND SWORN to before me this, day of Affiant/s exhibited to me his/their Commiunity Tax Certificate Nos. __—___ and __ Issued at on Doc. No. Page No. Book No. Series of 20 :