REPUBLIC OF THE PHILIPPINES )

PROVINCE OF TARLAC : S.S.

MUNICIPALITY OF BAMBAN )

AFFIDAVIT OF NON-OPERATION

I, ___________________________________, of legal age, Filipino, married, with

residence and postal address at ___________________________________, Philippines, after
having been duly sworn to in accordance with law, do hereby depose and say:

1. That I am the Proprietor of ___________________________________, a business entity

duly organized and existing under the laws of the Philippines with principal office at
______________________________________________________________________;

2. ___________________________________ is a duly registered business concern by the

Department of Trade and Industry (DTI);

3. From 2017 to 2019, ___________________________________ stopped its operation due

to personal reasons;

4. That this affidavit is being executed in order to attest to the truth of the foregoing
circumstances and for the purpose of complying with the reportorial requirements of the
Municipal Government of Bamban, Tarlac and the Department of Trade and Industry.

IN WITNESS WHEREOF, I have affixed my signature on this

___________________________________ at Bamban, Tarlac 2317, Philippines.

___________________________________
Affiant
Driver`s License No. ___________________________________
Valid Until: ___________________________________

SUBSCRIBED AND SWORN to before me this

___________________________________ at Bamban, Tarlac, Philippines, affiant exhibited to
me her positive identification duly noted above below her name and signature, known to me and
to me known to be the same person who executed foregoing instrument and acknowledged to me
that the same is her free act and deed and that she voluntary executed the same and understood
all the contents thereof.

WITNESS MY HAND AND SEAL

Doc. No. ______;

Page No. ______;
Book No. _____;
Series of 2019.