REPUBLIC OF THE PHILIPPINES)

) S.S

AFFIDAVIT OF DESISTANCE

I, ABC, of legal age, married, Filipino and a resident of XYZ, after having
been duly sworn in accordance with law, hereby depose and state that:

1. I am the complainant in a complaint for Reckless Imprudence Resulting

in Homicide docketed as NPS _______, now pending before the Provincial
Prosecutors Office of Cavite;

2. Upon reflecting over the incidents that transpired, I have come to realize
that the filing of the said complaint was only due to a misunderstanding
and confusion between us and that no one is to be blamed for the same
was an accident which no one wanted to happen;

3. I am no longer interested in the prosecution of the said case and

abandons as I hereby abandon all my claims whatsoever against
____________________;

4. I have voluntarily and freely executed this affidavit to attest to the truth
of the foregoing and for the dismissal of the case aforementioned .
Affiant further sayeth naught.
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of
January, 2012 at _________________________, Philippines.

ABC

SUBSCRIBED AND SWORN TO before me this ____ day of January, 2012

in ___________________________, Philippines, affiant exhibiting to me his
_____________________, issued on ________________ at ________________________,
Philippines.

NOTARY PUBLIC

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2012.