The place where the affidavit is executed

REPUBLIC OF THE PHILIPPINES) C I T Y O F CAGAYAN DE ORO ) S.S.

Caption
COMPLAINT-AFFIDAVIT
That I, Vincy Jane A. Polinar, of legal age, married, Filipino and a resident of c/o South Bank, Kauswagan Branch, Cagayan de Oro City, after having been duly sworn to according to law hereby depose and say:

PERSONAL CIRCUMSTANCES
1. That I am the Loan Manager of South Bank, Kauswagan Branch, Cagayan de Oro City. I am executing this affidavit in behalf of South Bank, being the complainant herein.

2. In behalf of the said Rural Bank, I am filing a formal complaint for Estafa thru Falsification of Public Document and /or thru Forgery against respondent Apipa G. Guro [hereinafter ´Respondentµ], a resident of Vamenta, Carmen, Cagayan de Oro City .

3. On October 31, 2007, Respondent using the name of, and misrepresenting herself to be Doña Añiqa Macarambon-Bacsarpa, submitted a loan application, purportedly signed by the Spouses, by forging their signatures with South Bank, Kauswagan Branch, Cagayan de Oro City amounting to PhP 5,000,000.00.

BODY

4. As security for the payment of the said loan, Respondent submitted as collateral thereof a parcel of land described in TCT No. T-178439
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and

executed a Real Estate Mortgage over the said land in favor of South Bank.
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5. On December 6, 2007, the loan application amounting to Philippine Pesos: Five Million (PHP 5,000,000.00) was approved by South Bank and the proceeds thereof were delivered to the Respondent, receipt of which is
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Annex ´Aµ.

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Annex B

evidenced by a manager·s check issued by the bank and withdrawn by the Respondent. 3 Photocopy of the said check is hereto attached as Annex C hereof;

6. On January 6, 2007, South Bank found out that respondent falsified and/or

forged the above mentioned documents. It also found out that Respondent misrepresented herself to be Doña Añiqa Macarambon-Bacsarpa when in truth and in fact the former, as found by the bank, is Apipa G. Guro.
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Respondent·s real identity was discovered by the bank when one of it·s employees identified her as an acquaintance as they live in the same barangay and is personally known to her;

7. Respondent·s unlawful acts were discovered by the bank when the latter tried to collect from the Spouses Bacsarpas who refused to pay on the ground that they did not apply for a loan, much less mortgage the land covered by subject land title in favor of South Bank;

8. The unlawful acts by Respondent caused damage and prejudice to South Bank in the amount of PhP 5,000,000.00, the amount released to respondent as proceeds of the loan, including interest of twelve percent (12%) per annum;

9. South Bank spent PhP 30,000.00 for attorney·s fees for filing the complaint affidavit .

10.

That I am executing this affidavit for and behalf of the South

Bank, Kauswagan, Cagayan de Oro City, being the Loan Manager thereof, to file a formal complaint of Estafa through Falsification of Public Documents and/or through Forgery against Apipa Guro.

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Annex C .
Annex ´Dµ.

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IN WITNESS WHEREOF, I have hereunto affixed my signature for and in behalf of the complainant South Bank Kauswagan, Cagayan de Oro City this 8th day of December 2009, at Cagayan de Oro City.

ATTESTATION CLAUSE
Vincy Jane A. Polinar Affiant

JURAT

NAME AND SIGNATURE OF AFFIANT

SUBSCRIBED and SWORN to before me this 8th day of December, 2009, at Cagayan de Oro City. I hereby certify that I have personally examined the abovenamed affiant and that I am satisfied that the foregoing statements were given by him voluntarily and of his own free will.

Azrifa A. Mamutuk Associate Prosecution Attorney II

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