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- SA P L E FORM

CER TIFIC ATE OF DISS OLUTIO N

OF

(NAME OF CORPORA TION )

KN O W AL.L M EN BY THESE PRESENTS:

That we, the undersigned, the Cha i rm a n and the Secret ar y of the st ockho lder ' s m eet in g an d t h e
maj rity members of the Board of Directors of_(NAME OF CORPO RATION ) , a corpor a t i on orga ni zed and
existing under by virtue of the la ws of the Phi lippines wit h· principal offi ce at
_____ _____ ___ _ , do hereby CERTIFY t hat :

1. On (DATE) , at the special r:n eeting of the st ockholde rs of the said corporat ion , up on ca l l
by the Board of Directors in accordance with Section 118 of the Corporation Code, held at its p rin cipa l
offic for the purpose of secu ring the affirmution by vote of st ockho lder s owning at least t wo-t hird s
( 2/ 3 ) of the total outst andi ng capi t al st ock, after due com plianc e of the re qui red newspaper publi ca t ion
and otice of the meeting to eac h stockholder, all within the reglem ent ary p er iods spec ifi ed by sai d Sec.
118, for the purpose of diss olut ion of the corpor at ion .

2. W rit t en notice of the pr opose d di ss olut ion was duly published once a week for t h4re e
consecutive weeks in (Name of Newspaper ), a n ewspa per of general circulation, and that each
st ockholder w as duly se rv ed notice of the meeting ca ll ed fo r, by personal service at least t hirty (30 ) days
prio r to said m eet ing .

3. In pursuance and by virtue of sa id notice, there app ea re d in per son on the dat e stated for the
mee t in g the stockholders representing and owning a t least t wo-t hirds (2/ 3) of t he total out st anding
capi t al st ock of the corporat io n.

4. Said meeting of the st ockh older s, upon motion duly made and seconded, the fo llowin g mat t ers
and RE SOL UTION , which had been duly approved previously by the Board of Direct or s, w as sub m it t ed to
the tockh older s for adoption by the affirmative vote of st ockholders owning at least the r eq uired t wo-
thir s (2/3) of the total out st a n ding ca p it al stock of the corpo rat ion .

RESOLUTION

" WHER E AS, the undersigned Stockholders of the Corp orat ion dee m it adv isable a nd in the best
int er est s of the Corpo rat ion tha t the Corporation be dissolved and liq uid at ed;

NO W, THEREFORE, BE IT RE SOLVED, as it is hereb y resolved, pursuant .to Sect ion 11 8 of the


Cor poration Code of the Ph i li ppine s, that this corporation be forthwith dissolved eff ect ive (DA TE)."

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