REPUBLIC OF THE PHILIPPINES)

MALOLOS CITY, BULACAN) S.S.

SWORN STATEMENT

I, ARNEL J. ANTING, of Legal age, Filipino citizen and with residence address at No.
0002 A(C) Victoria Street Vista Verde North Vill. Caybiga, Caloocan City, after being duly
sworn to in accordance with law, do hereby depose and say that:

1. I am owner of the ARJON SARI-SARI STORE located at Ulingan East Lawang Bato,
Valenzuela City with registered Business Permit at the City of Valenzuela with
Business Account No. 19-139076;

2. The last Gross Sales/Receipts of my business on DECEMBER 30, 2021 is

Preceeding CY: 0 and Current CY 0;

3. I closed my business ARJON SARI-SARI STORE on DECEMBER 30, 2021 due to

BANKCRUPTCY;

4. I am executing this affidavit to attest to the truth and veracity of the foregoing
declaration and for whatever purpose this may lawfully serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this day of 19 TH day of

January 2022 at MALOLOS CITY, BULACAN

ARNEL J. ANTING
Affiant

SUBSCRIBED AND SWORN, to before me this day of 19 TH day of January 2022 at

MALOLOS CITY, BULACAN. Affiant exhibiting to me his TIN ID with No. 275-020-324-000.

Doc. No. _____;

Page No._____;
Book No._____;
Series of 2022