Republic of the Philippines)

_____________________) s.s.

AFFIDAVIT OF CANCELLATION
WITH NO FINANCIAL OBLIGATION

I, __________________, of legal age, Filipino, single/married, and with residence

located at _______________________________________, after having sworn to in
accordance with law, hereby depose and state:

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

___________________ located at ____________;

2. That the above-said business was duly registered at the Department of Trade
and Industry (DTI) on _________ and was issued Certificate of Business Name
Registration No. __________;

3. That at present I am causing the cancellation due to the facts of the change of
name, status and residence of the owner of the said business;

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

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

declarations under penalties of perjury to respectfully request the DTI to Cancel
Certificate of Business Name Registration No. _____________, moreover to
serve all legal intents.

IN WITNESS WHEREOF, I hereby affix my signature this _______________ at

_______________________.

_________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _______________ at

_________________________ affiant exhibiting to me her ______________ ID No.
_____________, bearing her photograph and signature and avowed the truthfulness of
the foregoing declarations.

Doc. No. ____

Page No. ____
Book No. ____
Series of ____