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I, _____________, Filipino, of legal age, (single / married / widow), and a resident of

_____________, Philippines, after being sworn to in accordance with law, depose and state:

That I know the person of __Respondent__, who is a resident of _____________, Philippines;

That sometime in the morning of __date of issue__, at __place of issue__, Philippines, the said
__Respondent__ issued in my favor a __Name of Bank__ Check No. _____________ in the
amount of P_____________ as supposed payment for the loan accommodation of
P_____________, which I have extended to (him/her);

That the said check is drawn against the account of the said __Respondent__ at __Name of
Bank__ with Account No. _____________;

That at the time the said __Respondent__ issued the delivered the said check to me, (he/she)
made the assurance and representation that the said check is a good check and would be covered
by sufficient funds when presented for payment;

However, when the above-mentioned check was deposited, the same was dishonored and
returned by the bank on the ground that the same was drawn against a "CLOSED ACCOUNT".A
true and faithful machine reproduction of the said check is hereto attached as Annex "____";

As such, I immediately notified said __Respondent__ of the dishonor and return of the said
check and demanded from (him/her) that (he/she) make good the said check within
_____________ (____) days from receipt thereof. A true and faithful machine reproduction of
my demand letter to (him/her) is hereto attached as Annex "____"

When said __Respondent__ failed to heed my demands, I endorsed the said check to my legal
counsel who immediately sent a formal demand letter through registered mail with return card on
_____________, which was received by the said __Respondent__ on _____________.As of date
however, __Respondent__ has unjustifiably ignored all these demands to pay the said account
and/or to redeem the said returned check. A true and faithful machine reproduction of my
demand letter to (him/her) is hereto attached as Annex ____"

I am therefore executing this Complaint-Affidavit in support of the charges for Violation of

Batas Pambansa Bilang 22 against the said __Respondent__, who may be served with subpoena
and other processes of this Honorable Office at (his/her) last known address at _____________,
Philippines;

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________,

Philippines.
 

SUBSCRIBED AND SWORN to before me this _____________ at _____________.I hereby

certify that I have examined the Affiant and that I am fully satisfied that (he/she) has voluntarily
executed and understood the contents of (his/her) Complaint-Affidavit.

Administering Officer


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The undersigned, _____________, accuses _____________ of the crime of ACTS OF

LASCIVIOUSNESS, committed as follows, to wit:

That on or about _____________, at about _________ (a.m./p.m.), in the City/Municipality of

_____________, Province of _____________ and within the jurisdiction of this Honorable
Court, the said accused _____________ did then and there willfully, unlawfully, and feloniously
embrace the undersigned, when the latter was about to enter a public toilet, holding her breasts
and taking liberties upon her person by force and against the will of the undersigned.

Contrary to law.

_____________, Philippines, __Date__.

COMPLAINANT

(JURAT)

Witnesses:

___________________

___________________


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The undersigned, _____________, accuses _____________ of the crime of adultery, committed

as follows, to wit:

That on or about _____________, at about _________ (a.m./p.m.), in the City/Municipality of

_____________, Province of _____________ and within the jurisdiction of this Honorable
Court, the said accused _____________ did then and there voluntarily, unlawfully, and
feloniously had sexual intercourse with her co-accused _____________, who is not her husband,
and the latter knowing her to be married to _____________, voluntarily, unlawfully, and
feloniously had carnal knowledge with her.

Contrary to law.

_____________, Philippines, __Date__

COMPLAINANT

(JURAT)

Witnesses:

________________

____________________


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The undersigned, _____________, accuses _____________ of the crime of FORCIBLE

ABDUCTION, committed as follows, to wit:

That on or about _____________, at about __________ (a.m./p.m.), in the City/Municipality of

_____________, Province of _____________ and within the jurisdiction of this Honorable
Court, the said accused, did then and there willfully, unlawfully and feloniously abduct a woman
named _____________ who is a minor of 14 years while she was on her way home from school,
taking and carrying her away on board a black passenger van, against her will and with lewd
designs.

Contrary to law.

_____________, Philippines, __Date__.

COMPLAINANT

(JURAT)

Witnesses:

________________

__________________


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The undersigned, _____________, accuses _____________ of the crime of ARSON, committed

as follows, to wit:

That on or about _____________, at about _________ (a.m./p.m.), in the City/Municipality of

_____________, Province of _____________ and within the jurisdiction of this Honorable
Court, the said accused did then and there willfully, and feloniously set on fire the building
belonging to _____________, knowing it to be occupied by at that time by one or more persons,
to the damage and prejudice of the said _____________ in the amount of P_____________.

Contrary to law.

_____________, Philippines, __Date__.

PROSECUTOR

Witnesses:

____________________
____________________


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The undersigned, _____________, accuses _____________ of the crime of HOMICIDE,

committed as follows, to wit:

That on or about _____________, at about _________ (a.m./p.m.), in the City/Municipality of

_____________, Province of _____________ and within the jurisdiction of this Honorable
Court, the said accused, armed with a jungle knife, and with evident intent to kill, did then and
there willfully, unlawfully, and feloniously assault, attack and wound one _____________
inflicting mortal wounds in various parts of his body resulting to his instantaneous death.

Contrary to law.

_____________, Philippines, __Date__.

PROSECUTOR

Witnesses:

____________________
____________________

(Certification of Preliminary Investigation)


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The undersigned, _____________, accuses _____________ of the crime of SWINDLING /

ESTAFA, committed as follows, to wit:

That on or about _____________, at about _________ (a.m./p.m.), in the City/Municipality of

_____________, Province of _____________ and within the jurisdiction of this Honorable
Court, the said accused having received from _____________ a variety of Ready-to-Wear goods
valued at P_____________ for the purpose of selling the same on commission, under the express
obligation of holding the same in trust for _____________ and to remit the proceeds of the sale
of the said goods, if sold, or to return the same in case of non-sale, within ________ (____) days
from receipt thereof, the said accused did then and there, willfully, unlawfully, and feloniously,
misappropriate and convert the said goods or their proceeds to his own personal use and benefit
to the damage and prejudice of _____________ in the amount of P_____________.

Contrary to law.

_____________, Philippines, __Date__.

PROSECUTOR

Witnesses:

____________________
____________________

(Certification of Preliminary Investigation)