REPUBLIC OF THE PHILIPPINES) _____________________________ ) S.S. AFFIDAVIT RE: TERMINATION OF BUSINESS I, (Name), of legal age, (marital status) and a resident of (address), after having been duly sworn in accordance with law do hereby depose and state: That I am the (designation) of the business name (Name of Business) which is registered with the Bureau of Internal Revenue (BIR); That I am applying for the termination of the business, (Name of Business), registered with the BIR in (date of registration), with Certificate of Registration OCN No. (certificate number), which I decided to close effective (effectively date of closure); That the reason for the termination is due to (state reason for closing the business); That the business has no outstanding liability and obligation; That I am executing this affidavit to attest to the truth of all the foregoing statements and for whatever legal purpose it may serve. IN WITNESS WHEREOF, I have hereunto set my hand this _________________ at _____________, Philippines. Printed Name and Signature Affiant CTC No: ______________ Issued on: _____________ At: ___________________ SUBSCRIBED AND SWORN to before me this __th day of _______________ at ____________, Philippines. Doc. No. : ________; Page No. : ________; Book No. : ________; Series of 20___.