REPUBLIC OF THE PHILIPPINES )

MAKATI CITY, METRO MANILA ) S.S.

AFFIDAVIT OF DESISTANCE
I, _______________, of legal age, Filipino, with residence address at
______________________________, Metro Manila, after having been duly sworn to
in accordance with the law, hereby depose and say that:
1.

I am the private complainant in Criminal Case No.

____________ entitled, _________________-, pending before the

______________________.
3.

In connection with the foregoing criminal case, the

Parties were able to communicate with each other and have come
to an amicable settlement regarding the subject matter of the
same.
4.

In view thereof, I am no longer interested in pursuing

the criminal case against Defendants;

5.

This affidavit is being executed by me, of my own free

will and volition, for the purpose of seeking a dismissal of any

pending claim or signifying mt intention to desist from further
prosecuting Defendants, hereby waiving all rights and claims due
to me arising from said incident, now and hereafter;
6.

The foregoing statements have been fully read by me

and/or read and translated to me in Filipino, a language which I

understand, that the same are true and correct to the best of my
knowledge and belief.
AFFIANT FURTHER SAYETH NAUGHT.

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

at __________, Metro Manila.

_____________________________
Affiant

SIGNED,

SUBSCRIBED

AND

SWORN

to

before

me

this

___________________ in _________________ the affiant exhibiting to me his

____________, a competent evidence of his identity bearing his photograph and
signature as defined by Section 12 of the Rules on Notarial Practice.
Doc. No.

Page No.

Book No.

Series of 2013.