Republic of the Philippines )

Province of Southern Leyte ) s.s.

Municipality of Tomas Oppus )
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AFFIDAVIT OF CESSATION OF BUSINESS

I, AMELITO L. DIGNOS, of legal age, married, Filipino and a resident of Brgy.

Mahayahay, Malitbog, Southern Leyte, Philippines, after having been duly sworn to in
accordance with law, hereby voluntarily depose and state:

That I was issued a franchiseto operate atransport public utility within the municipality of
Malitbog, Southern Leyte per Confirmation/Certification issued by the MCH Franchise
Committee of Malitbog, southern Leyte;

That however, the Honda TM125covered by the said franchise with Engine/Motor No.
CG123E-024633PH, Chassis No. TM125-972-33033 is no longer serviceable or cannot be used
for the said purpose due to serious damage;

That I am applying for the termination of the business effective today November 06,
2018 considering that I already ceased to operate since I could no longer afford to replace such
motorcycle;

That the business has no outstanding liabilities and obligations;

That I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever lawful purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of November 2018 in
the Municipality of Tomas Oppus, Southern Leyte, Philippines.

AMELITO L. DIGNOS
Affiant
DRIVER’S LICENSE NO: NO1-96-201237

SUBSCRIBED AND SWORN to before me this 6 th day of November 2018 at Tomas

Oppus, Southern Leyte, Philippines.