REPUBLIC OF THE PHILIPPINES }

} S.S

AFFIDAVIT OF BUSINESS CLOSURE/ RETIREMENT

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

, after having been duly sworn to in accordance with
law, hereby depose and state that:

1. I am the owner/ representative of a business establishment named

with Tax Identification Number (TIN
located at

2. That the business has been negatively impacted in a material manner by

the COVID-19 pandemic which resulted in the decline in the revenue and
employees being infected with the disease.

3. That as a result thereof, the business resorted closure.

4. That I attest to the truthfulness of the foregoing

IN WITNESS WHEREOF, I have hereunto set my hand this

in .

Affiant
 
SUBSCRIBED AND SWORN to before me this in
, Philippines, affiant personally appeared before me and personally
identified to me by her competent evidence of identity as follows:
.

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