(Affidavit of Desistance Violation of BP 22)

Republic of the Philippines)

Province of _________________) S.S.
City/Municipality of____________)
x----------x

AFFIDAVIT OF DESISTANCE
I,___________, of legal age, Filipino and a resident of
Bacolod City, after having been duly sworn in
accordance with law, hereby depose and say:

1.That I am the private complainant in the Criminal

Cases Nos.____________to____________entitled "People
of the Philippines vs._____________"; for Violation of
Batas Pambansa Bilang 22 pending before the
Municipal Trial Court, Branch______, ____________City,
Philippines.

2.In this regard, the accused___________has already

paid in full the amount represented by the checks
subject of the above-mentioned cases, to with:
Criminal Case No.Check No.Amount

3.That in view of the payment in full by the accused,

I would like to manifest that I am no longer
interested in the prosecution of the aforementioned
criminal cases and I am respectfully requesting the
Honorable Public Prosecutor to move for the
dismissal of the aforementioned cases against the
accused.
IN WITNESS WHEREOF, I have hereunto set my hand
this_____________ at___________, Philippines.

AFFIANT

(JURAT)