AFFIDAVIT OF CANCELLATION

WITH NO FINANCIAL OBLIGATION

I, , of legal age, Filipino, with address at , after

having sworn to in accordance with law, hereby depose and state that:

1. I am a registered owner of a business under the trade name

located at ;

2. The above-stated business was duly registered at the Department of Trade and
Industry (DTI) on and was issued Certificate of Registration
with No. .

3. At present, I am causing the cancellation of the said registered business due to

change of territorial scope.

4. As far as my personal knowledge as the registered owner, I attest to the fact that
has no outstanding financial obligation to any individual, public
or private corporation or entities,

5. I am executing this affidavit to the attest the truthfulness of the foregoing

declarations under penalties of perjury to respectfully request te DTI to CANCEL
Certificate of Registration No. , and for other legal purposes.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby set my hand this in

, Philippines.

AFFFIANT

SUBSCRIBED AND SWORN to before me, this in

, affiant who exhibited her government ID as
competent proof of her identity.

Doc. No.
Page No.
Book No.
Series of 2018