REPUBLIC OF THE PHILIPPINES)

) S.S.
MALABON CITY )
x----------------------------------------------x

AFFIDAVIT-COMPLAINT

I, _____________________ of legal age, single and resident of

__________________________ after having been sworn to in accordance with law do
hereby depose and state, THAT:

1. I am executing this affidavit to file a criminal complaint for ____________

punished under ______________ of the Revised Penal Code of the Philippines, as
amended, against _____________________ of #_______________________ committed
as follows:

5. I am executing this affidavit to attest to the truthfulness of the foregoing facts and
in support of the above complaint.
July 11, 2007, Malabon City.

Complainant

SUBSCRIBED AND SWORN to before me this _____ day of July 2007 in Malabon

City, Philippines.