Republic of the Philippines

Department of Justice
PROVINCIAL PROSECUTOR OFFICE
_____________________________________
_____________________________________
_____________________________________

_________________________ NPS Docket No.

Complainant, _________________________

-versus-
-for-
_________________________
Respondent. _________________________
_________________________
_________________________
_________________________

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

THE OFFICE OF THE PROVINCIAL PROSECUTOR

_________________________
_________________________
_________________________

RE: SUPPLEMENTAL AFFIDAVIT AND ADDITIONAL EVIDENCE

DEAR SIR/MADAM:

Good day! The undersigned complainant, most respectfully

submits the following to supplement the criminal complaint I filed against
_________________________:

ANNEX DESCRIPTION
“A” A copy of my Supplemental Complaint-Affidavit
and series

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 “B” A copy of the Affidavit executed by my witness,
and series _________________________, with attachments:

a. A copy of the LTO Certification

b. A copy his LTO Non-Professional Driver’s

License;

c. A copy of the Certificate of Registration

(CR of the motor vehicle driven by
respondent _________________________,
registered under the name
_______________________;

d. A copy of the expired LTO Official Receipt

(OR) of the motor vehicle driven by
respondent ________________________;

e. A copy of the Medical Certificate issued by

Dr. _________________________;

f. A copy of the Summary of Fees issued by

the ________________________, the
hospital where victim,
_________________________, was
confined for immediate medical care.

Respectfully yours,

_____________________________
Complainant
Contact No. ___________________

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