REPUBLIC OF THE PHILIPPINES )

Province of____________________) S.S.

City/Municipality of______________)
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AFFIDAVIT OF DESISTANCE
I, ________________(name of affiant)____________, Filipino, of legal age, [single]/[married to
_________(name of spouse)_________], and a resident of ___________________(address of
affiant)_______________, after having been duly sworn in accordance with law, hereby depose
and state:
1. That I am the complainant in the criminal case filed against ________________, which
is recorded as Case No. ______ before Prosecuting Fiscal __________________ of the
[city]/[municipality] of _________ province of __________ for grave threats;
2. That after boxing incident while playing chess at Igorot Park in Baguio and thinking that
it was just a case of misunderstanding between me and my chess opponent, I have
decided to withdraw my accusations against ____________________________;
3. That I have executed this affidavit in order to attest to the truth of the foregoing
circumstances and that my desistance to pursue said case is of my own free will and
volition and that there was no force, intimidation, coercion or consideration that took
place for me to make such decision.
IN WITNESS WHEREOF, I have hereunto set my hand this ___th day of _____________,
_________ at the [City]/[Municipality] of ______________.

_______________
Complaining Witness
JURAT
_______________
Public Prosecutor