REPUBLIC OF THE PHILIPPINES )

Province of ____________________ ) S.S.

City/Municipality of ______________ )
x---------------------------------------x

AFFIDAVIT OF DESISTANCE

I, ________________(name of affiant)____________, Filipino, of

legal age, [single]/[married to _________(name of
spouse)_________], and a resident of
___________________(address of affiant)_______________, after
having been duly sworn in accordance with law, hereby depose and
say:

1. That I am the complaining witness for

__________________________________________________
against _____________________________ in the case entitled
“_____________________vs.____________________”,
Criminal Case No. _________, ________(court branch)____;

2. That the accused, Mr/Mrs/Ms.

_________________________ have paid me today
(___date___) the amount of
________________________________ Pesos (Php _____).

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 case.

4. I am respectfully requesting the Honorable Public Prosecutor

to move for the dismissal of the aforementioned case against
the accused, Mr/Mrs/Ms. __________________________.

(Signature of Affiant)
____________________________
(Name of Affiant)

(JURAT)

_____________________________
Public Prosecutor

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