REPUBLIC OF THE PHILIPPINES)
Province of Nueva Ecija )
Municipality of Cuyapo )S.S.
AFFIDAVIT OF BUSINESS CLOSURE
I, JUANA DELA CRUZ, of legal age, Filipino, single, and a resident of Cabaducan East,
Nampicuan, Nueva Ecija, Philippines after having been duly sworn to in accordance with law, do
hereby depose and state that:
1. I am the owner and proprietor/operator/manager of XXX CARE MART AND MEDICAL
SUPPLY, located in Brgy. District VI (Pob. VI) Cuyapo, Nueva Ecija – Region III (Central
Luzon);
2. Such business was registered with the Department of Trade and Industry (DTI), Local
Government of Cuyapo, Nueva Ecija – Business Permit and Licensing Division (LGU), and
Bureau of Internal Revenue – Revenue District Office No. 23A (BIR);
3. I intend to file an application for closure of the above-mentioned business with the
concerned government offices/ agencies due to lack of time to manage the same; and
4. I am executing this Affidavit to attest to the truth of the foregoing statements, and for
whatever legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of August 2023 in
Cuyapo, Nueva Ecija, Philippines.
JUANA DELA CRUZ
Affiant
SUBSCRIBED AND SWORN to before me this 15th day of August 2023 in Cuyapo, Nueva
Ecija, Philippines, Affiant exhibited to me her Driver’s License with No. C11-11-111111 valid
until 23 October 2023, as competent evidence of her identity.
NOTARY PUBLIC
Doc. No. 30; ATTY. NERIE D. BRITANICO
Page No. 7;
Book No. II;
Series of 2023.