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REPUBLIC OF THE PHILIPPINES

Department of Justice
OFFICE OF THE CITY PROSECUTOR
City of Mandaue

A,
Complainant,

-versus-
I.S. No.
For: Slight Physical Injuries

B,
Respondent.

x-------------------------------------------x

AFFIDAVIT-COMPLAINT
I, A, of legal age, Filipino citizen, single, residing at Mabolo, Cebu City, after having
duly sworn to in accordance with law do hereby depose and say:

1. That I am the complainant in the above-entitled case;

2. That I am formally charging respondent B, residing at Talamban, Cebu City, for the
crime of Slight Physical Injuries penalized under Art. 266 of the Revised Penal
Code, committed as follows, to wit:

a) THAT on 4:00 o’clock in the afternoon of June 15, 2019, while I was at
Parkmall in Mandaue City. I encountered the respondent inadvertently

b) THAT due to such encounter, respondent was bewildered and a heated


argument ensued between us;

c) THAT while having the said argument with the respondent, he suddenly
approached me, punched my face in the presence of my friend, C;

d) THAT on the same day, I went to Hospital to have an examination of my


face and the injuries I sustained, and the doctor recommended for a healing
and rest period of seven (7) days. Copy of the Medical certificate is attached
as Annex “A” hereof;

e) THAT the expenses I incurred for seeking medical assistance totaled to


P1,500.00 representing doctor’s fee and medicines. Copy of Receipt No.
12345 is attached as Annex “B” hereof;

f) THAT on June 23, 2019, I filed a complaint before the barangay, and after
several hearings, no amicable settlement was reached between the parties
as evidence the Certificate to File Action which is hereto attached as Annex
“C”.
3. That I am executing this affidavit to attest to the truth of the foregoing statements,
and for the purpose of charging respondent B for the crime of Slight Physical
Injuries penalized under Art. 266 of the Revised Penal Code.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 25th day of


June 2019, in the City of Mandaue.

A
Complainant/Affiant

SUBSCRIBED AND SWORN TO before me this 25th day of June 2019,


in Mandaue City.

WILFREDO S. PANGANDOYON, Jr.


City Prosecutor

CERTIFICATION
I hereby Certify that I personally examined the affiant and that I am satisfied that
he voluntarily executed and understood his complaint-affidavit.

WILFREDO S. PANGANDOYON, Jr.


City Prosecutor