(Affidavit of Desistance Violation of BP 22) Republic of the Philippines) Province of _________________) S.S.

City/Municipality of____________) x----------x AFFIDAVIT OF DESISTANCE I,___________, of legal age, Filipino and a resident of Bacolod City, after having been duly sworn in accordance with law, hereby depose and say: 1.That I am the private complainant in the Criminal Cases Nos.____________to____________entitled "People of the Philippines vs._____________"; for Violation of Batas Pambansa Bilang 22 pending before the Municipal Trial Court, Branch______, ____________City, Philippines. 2.In this regard, the accused___________has already paid in full the amount represented by the checks subject of the above-mentioned cases, to with: Criminal Case No.Check No.Amount 3.That in view of the payment in full by the accused, I would like to manifest that I am no longer interested in the prosecution of the aforementioned criminal cases and I am respectfully requesting the Honorable Public Prosecutor to move for the dismissal of the aforementioned cases against the accused. IN WITNESS WHEREOF, I have hereunto set my hand this_____________ at___________, Philippines. AFFIANT (JURAT)