AFFIDAVIT OF DESISTANCE

REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

(the persons and circumstances below is fictional, please revise)

I, Juan del la Cruz, of legal age, single, and a resident of # 123 Main
St., Malate, Manila, after having duly sworn to in accordance with law hereby
depose and state:

1. I am the complaining witness for Serious Physical Injuries against

Jesus Santos in the case entitled "People of the Philippines versus Jesus
Santos", Criminal Case No. 12345, Metropolitan Trial Court, Branch No. 11,
City of Manila.

2. After my sober and soul searching assessment and analysis of the

incident, I have realized that because I was not wearing my eyeglasses and it
was dark, I can not point out, without a doubt the accused or any other
person/s who inflicted harm against me.

3. Since I could not state with certainty and without doubt the liability of
Jesus Santos, in fairness to him, I am permanently withdrawing my complaint
against him. I clear him of whatever responsibility or liability to me.

4. I hereby inform the City Prosecutor of Manila that I am withdrawing

my complaint for Serious Physical Injuries in Criminal Case No. 12345
entitled"People of the Philippines versus Jesus Santos", Metropolitan Trial
Court, Branch No. 11, City of Manila.

5. I likewise request the Metropolitan Trial Court, Branch No. 11, City of
Manila to dismiss with prejudice the said criminal case.

IN WITNESS WHEREOF, I hereby set my hand this __ day of September

20__ at the City of Manila.

Juan de la Cruz
Complaining Witness

SUBSCRIBED AND SWORN to before me this 22nd day of January 20__ at the
City of Manila, Philippines.
 Romeo Abad
Public Prosecutor