Republic of the Philippines ) Province of ____________________) S.S.

City/Municipality of _____________) x----------------------------x

AFFIDAVIT OF DESISTANCE

I, _____________, of legal ages, Filipino, (single / married / widow), and a resident of _____________, Philippines, after having been duly sworn in accordance with law, hereby depose and say: 1 That I am the private complainant in the criminal case entitled "_____________" for (felony / offense committed) docketed as _____________ before _____________ Trial Court, Branch _______, _____________ City, Philippines; That I recently found out that the incident giving rise to the instant complaint was merely a result of a simple misunderstanding between me and the accused, thus, I have now come to a realization that accused never intended to commit any harm or damage upon my life, limb or property; In view of the foregoing, I finally manifest that I now completely and absolutely exonerate the accused _____________ from any liability in connection with the above-mentioned criminal case and that I am no longer interested, and I hereby desist, in prosecuting the said criminal case; That I execute this Affidavit of Desistance so that the above-mentioned criminal case be immediately dismissed and considered finally closed (and the bond posted by the herein accused be released to him); As such, I am respectfully praying that the aforementioned case against the Accused _____________ be dismissed and finally closed.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________ City, Philippines. AFFIANT
SUBSCRIBED AND SWORN to before me, this _____________, by the Affiant who is personally known to me (or whom I have identified through competent evidence of identity) and who exhibited his/her Community Tax Certificate No. _____________ issued at _____________ on _____________.

NOTARY PUBLIC Doc. No. ______; Page No. ______; Book No.______; Series of 2011