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Affidavit To Close Business

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REPUBLIC OF THE PHILIPPINES)

VALENCIA CITY , BUKIDNON) S.S.

AFFIDAVIT

RE: TERMINATION OF BUSINESS

I, KENNETH ARTHUR ANG LI, of legal age, single and a resident of Poblacion,
Valencia, Bukidnon, after having been duly sworn in accordance with law do hereby depose and
state:

That I am the Proprietor/ Manager of I Protek Emission Center which is registered with the
Bureau of Internal Revenue (BIR);

That I am applying for the termination of I Protek Emission Center, registered with the BIR
on___________, with Certificate of Registration OCN No._________ which I decided to close
effective ____________________;

That the reason for the termination is due to the termination of Franchise done by the
Department of Transportation (DOTR) ;

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.

KENNETH ARTHUR ANG LI


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___.

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