REPUBLIC OF THE PHILIPPINES )

QUEZON CITY )

AFFIDAVIT OF NO OPERATION

KNOW ALL MEN BY THESE PRESENTS:

I, ______________________________________, of legal age, married, Filipino citizen, and a resident

of ______________________________________________________________, after having sworn to in
accordance with law, hereby depose and state:

1. That I am the registered owner of a business under the trade name

__________________________ located at ________________________________;

2. That the above-said business has secured business permit from the Quezon City Hall’s
Business Permit and License Office;

3. That in Year ________, said business stops its operation due to the termination of the
contract between said business and the owner of the building;

4. That I am not aware that said business permit must be retired and the business plate
must be surrendered to QC BPLO;

5. That I am causing the execution of this affidavit and submitting the Termination
documents as well as the Certification of the barangay where the business is located
to prove that said business is no longer existing since
_____________________________;

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

declarations under penalties of perjury and to respectfully request the QC
BPLO to CANCEL Business Permit No. _______________,, moreover to serve all legal
intents.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby affix my signature this 10 th day of June 2016 at Quezon City,
Philippines.

_______________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 10th day of June 2016 at Quezon City. Affiant
exhibiting to me his Driver’s License with license number __________________, bearing her photograph
and signature and avowed the truthfulness of the foregoing declarations.

Notary Public

Doc. No. ________

Page No. ________
Book No. ________
Series of 2016