REPUBLIC OF THE PHILIPPINES )

PROVINCE OF MASBATE )
MUNICIPALITY OF SAN JACINTO ) S.S

AFFIDAVIT
RE: TERMINATION OF BUSINESS

I, _________________, of legal age, and a resident with postal address at

_________, San Jacinto, Masbate, Philippines, after having duly been sworn to in
accordance with Law hereby depose and say that:

1. I am the owner of the business name _______;

2. That a business permit was issued to me on __________ by the Office of the
Mayor;
3. That the business is registered with the Department of Trade and Industry
(DTI) and with the Bureau of Internal Revenue (BIR), with Certificate of
Registration No. ______________ which I decided to close effective
___________
4. That the reason for the termination of business is due to ___________
5. That the business has no outstanding liability and obligation;

6. Finally, that I am executing this affidavit to attest to the truthfulness of the

foregoing facts and statement and for whatever legal purpose that it may
serve.
IN WITHNESS WHEREOF, I have unto set my hand this 28th of July,
2022, in San Jacinto, Masbate, Philippines.

____________________
AFFIANT

SUBSCRIBED AND SWORN to before me this 28th of July, 2022, in San

Jacinto, Masbate, Philippines, affiant ________________, personally appeared
before me and exhibited to me her ___________ as a valid proof of identification.

Doc. No.______;
Page No. ______;
Book No.______;
Series of 2022