Complaint Affidavit BP 22

Republic of the Philippines )

____________________________ ) S. S.
x-----------------------------------x

COMPLAINT AFFIDAVIT
I, ________________________________, Filipino, of legal age, with postal address at
_____________________________________________ , after being duly sworn in to accordance
with law, hereby depose and say:

1. That I am filing a complaint against __________________________________ for

Estafa and for violation of BP 22, who can be served with summons and notices at
_________________________________________________________________.

2. That sometime on _________________________ at my residence in the City of

Manila, _____________________________ convinced me to take her check for rediscounting
representing that the checks will be good on the date indicated on the checks.

3. That the respondent delivered several checks and TWO (2) among several checks
are the subject of this case amounting to P235,000.00, to wit:

_____________________ BANK (Annex A) 03xxxxxx May 20, 2011 P58,750.00

_____________________ BANK (Annex B) 03xxxxxx June 20, 2011 P58,750.00

____________________
TOTAL: P117,500.00

4. That on the dates of the check I deposited the same and to my dismay they all
came back with annotations ACCOUNT CLOSED.

5. That she defrauded me to part with my money when he issued a check with
insufficient funds and worse account closed. She issues checks knowing very well that the same is
worthless.
 6. That upon bouncing of the checks I PERSONALLY delivered a demand letter to
the respondent giving her a chance to make good the payments of the checks but she chose to
ignore the same.

7. Herein attached is the Demand Letter delivered personally to the respondent on

____________, 2011 as ANNEX “C”.

IN WITNESS WHEREOF, I have affixed my signature this ___ day of ____________ 2011 in
_________________, Philippines.

_________________________________

Complainant

SUBSCRIBED AND SWORN to before me this ______ day of ___________,2011 in __________. I further
certify that I have personally examined the Affiant and I am satisfied that she voluntarily executed her Counter-Affidavit and
that she understood the contents of the same.

ADMINISTERING OFFICER

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