REPUBLIC OF THE PHILIPPINES )

CITY OF SAN FERNANDO, )

PROVINCE OF PAMPANGA ) S.S.
x------------------------x

AFFIDAVIT OF DESISTANCE
I, _________________________________, of legal age, single/married,
Filipino and a resident of ____________________________________, after
having been duly sworn to in accordance with law, do hereby depose and state:

1. That I am the complainant in the Criminal Case no. _____________

pending before the _____________________________;

2. That I am withdrawing my complaint on the ground that the case was

filed only as a result of misunderstanding and we both agreed now that
the incident should be considered as resulting from such
misunderstanding;

3. That considering the above-reason, I earnestly plead this honorable court

to dismiss the case against _______________________________;

4. That in executing this affidavit, I am not coerced, bribed, or intimidated,

and I am fully aware, that if the instance case will be dismissed by this
honorable court, it can no longer be revived.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of

____________________, in Guagua, Pampanga, Philippines.

________________________
COMPLAINANT

Subscribed and sworn to before me, this ___ day of __________________

______, in city of San Fernando.

Administering Officer