Affidavit of Cancellation-DTI

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REPUBLIC OF THE PHILIPPINES )

CITY OF TARLAC ) S.S.


PROVINCE OF TARLAC )

AFFIDAVIT OF CANCELLATION
That I, DWIGHT Y. MACABUHAY, of legal age, Filipino, married to Karen
Rose Macabuhay, resident of and with postal address at Sinilian 3rd, Camiling, Tarlac
after having been duly sworn to in accordance with law, depose and say that:

1. I am a registered owner of a business under the trade name Macbelly’s


Art Cafe located at 2nd Floor Sotero Building, Burgos St., Pob. B., Camiling,
Tarlac;

2. The above-stated business was duly registered at the Department of Trade


and Industry (DTI) on ______________ and was issued Certificate of
Registration with No. ______________;

3. At present, I am causing the cancellation of the said registered business


due bankruptcy;

4. The cancellation is not intended to defraud my creditors and that I have


no outstanding and pending financial obligation with my business or that I
had notified all my creditors of such cancellation, as the case maybe;

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


declarations under penalties of perjury to respectfully request the DTI to
CANCEL Certificate of Registration No. ______________, and for other legal
purposes.

IN WITNESS WHEREOF, we have hereunto set our hand this _______________ at


Tarlac City.

DWIGHT Y. MACABUHAY
Affiant
Passport No.: EC8080303

SIGNED IN THE PRESENCE OF:

_______________________ _______________________

BEFORE ME, at the locality and date above-mentioned came and personally
appeared the above-named party with their Competent Evidence of Identity, known
to be the same person who executed the foregoing instrument and acknowledge to
me that the same is his/her own free and voluntary act and deed.

WITNESS MY HAND AND SEAL

Doc. No._______;
Page No._______;
Book No._______;
Series of 2019.

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