Republic of the Philippines

DEPARTMENT OF JUSTICE
National Prosecution Office
Office of the City Prosecution
[City]

[Name] __________,
Complainant,
I.S. No. ___________

- versus - FOR: Murder under Act No.

3815 [The Revised Penal
Code]

[Name] __________,
Respondent.
x-------------------------------------x

COMPLAINT-AFFIDAVIT

I, [Name of Complainant], [Nationality], [Civil Status], of legal age, and

with residence address at [Residence Address], hereby accuse [Name of
Accused] (alias _____) with the crime of MURDER, committed as follows:

[Narrate how the crime was committed, identifying the qualifying

circumstances and aggravating and/or mitigating circumstances, if any.]

[Attach affidavits of witnesses if any]

TO THE TRUTH OF THE FOREGOING, I have signed this Complaint-

Affidavit on [Date] _________________________.

[Signature]
[Name]
Complainant-Affiant

[Use the following if oath taken before the prosecutor]

CERTIFICATION

SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of

[Month] [Year].

I hereby certify that I have personally examined the affiant and am

satisfied that he voluntarily executed and understood his complaint-
affidavit.

[Signature]
Investigating Prosecutor

[Use the following if oath taken before the notary public]

 SUBSCRIBED AND SWORN TO BEFORE ME, a notary public for the
City of [Place], this ____ day of [Month] [Year] at [Place], complainant
exhibiting to me his [Government issued ID] issued on [Date of issue] at
[Place of issue], bearing his photograph and signature.

The undersigned Notary Public certifies that he personally examined

the affiant and that he is satisfied that he voluntarily executed and
understood his complaint-affidavit

Notary Public

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 20___.