Republic of the Philippines)

City of Mandaluyong )S.S.

AFFIDAVIT OF CANCELLATION
I, _______________________, of legal age, Filipino, and with
postal address at No. ___________________________, after having
been sworn in accordance with law, do hereby depose and state as
follows:
1. I am the registered owner of a business under the name
_____________________ located at ___________________________;
2. The above-mentioned business was duly registered at the
Department of Trade and Industry on _______________ and was
issued
a
Certificate
of
Registration
under
____________________;
3. I am causing the cancellation of the said Certificate of
Registration for the reason of the change of ownership of the
said business;
4. Being the registered owner of the above business, I attest to
the fact that ___________________ has no standing financial
obligation to any individual or entities;
5. I am executing this affidavit to attest the truthfulness of the
foregoing statements.
IN WITNESS WHEREOF, I hereunto affix my signature this
___ day of ___________, 2015 at the City of Mandaluyong.

Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this ___ day of
____________, 2015 at ______________________, affiant exhibiting to
me his
_______________, issued at _________________ on
_________________.

NOTARY PUBLIC
Doc. No.:
Page No.:
Book No.:
Series of 2015.