Republic of the Philippines )

_________________)
_________________ ) SS.
x--------------------------------/

AFFIDAVIT OF BUSINESS CLOSURE

I, __________________., of legal age, married, Filipino, and a resident of
________________________, after having been duly sworn to in accordance with
the law, do hereby depose and state that;

1. I am the owner of ________________ under Permit No.

_________________ issued by the Office of the Municipal Mayor
of ______________________;

2. Said business is certified by the Office of the Barangay Captain of

______________________ dated January 17, 2024 as non-
operating and non-existing since January 2024;

3. I am applying for the termination and closure of my said business,

_________________ effective immediately since it is no longer in
operation since January 2024 up to present;

4. The business has no outstanding liability or obligation; and

5. I am executing this affidavit to attest to all the above facts and for
whatever legal purpose it may serve best.

IN TRUTH WHEREOF, I have hereunto set my hand this 17th day of January
2024 in _________________________, Philippines.

___________________
Affiant
Driver’s License # _________________

SUBSCRIBED AND SWORN TO before me this 17th day of January 2024 in

___________________, Philippines.

Doc No. _____;

Page No. ____;
Book No. ___;
Series of ____.

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