REPUBLIC OF THE PHILIPPINES}

}S.S.

AFFIDAVIT
(RE: TEMPORARY CLOSURE OF BUSINESS)

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

______________________________, after having been sworn in accordance with law,
hereby depose and say that:

1. I am the owner of __________________________ (the “Business”), with

business address at ____________________________________.

2. The Business temporarily closed and ceased operations during the period of
________________ until _________________ because of _____________________.

3. The Business has no outstanding liabilities and obligations.

4. I am executing this affidavit for whatsoever legal intents and purposes it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ______________ at

__________________, Philippines.

________________
Affiant

SUBSCRIBED AND SWORN to before me this ___th day of ______________,

by:

Name Proof of Identity Issued By: Valid Until:

Notary Public

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 20___.