REPUBLIC OF THE PHILIPPINES

______________________) s.s.

AFFIDAVIT OF CANCELLATION
WITH NO FINANCIAL OBLIGATION

I, __________________________________________, being duly sworn in

accordance with law, hereby depose and state that:

1. That I am the registered owner of a building under the Business Name

_______________________ located at _____________________________;

2. That the above-said business name was duly registered at the Department of
Trade and Industry (DTI);

3. That I cannot ascertain the whereabouts of the Original Business Name

Certificate of the said business name as evidenced by an affidavit of loss that
I executed. Said affidavit of loss is attached herein as Annex “A”;

4. That I am applying for the cancellation of my business name

_______________________________;

5. That the reason for the termination of the said business name is due to the
error in the registration of my building to the said business name in the official
receipt when it was registered;

6. That as far as my personal knowledge as the registered owner, I attest to the

fact that _______________________________ has no standing financial
obligation to any individual and to any public or private corporation or entities;

7. That I am executing this affidavit to attest to the truthfulness of the foregoing

declarations to request the DTI to cancel the business name
____________________ and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________________ in ________________________.

_____________________________________
Affiant

SUBSCRIBED AND SWORN to before me this ________________, in

________________________. Affiant exhibited to me her
________________________________.
WITNESS MY HAND and NOTARIAL SEAL, at the place and on the date
above-written.
Doc. No. ____;
Page No. ___;
Book No. __;
Series of ______.