Republic of the Philippines)

Done in the City of Baguio ) S.S.

AFFIDAVIT COMPLAINT

I, _______________________, of legal age, Filipino citizen and a resident of

No. ________________________________________, Baguio City, Philippines,
after having been duly sworn to in accordance with law, depose and state that:

I am formally charging ___________________________resident of No.

________________________________ Baguio City, did then and there willfully,
unlawfully, feloniously inflicted physical harm to my person causing injuries,
which is in violation of Art. 263 par. 4 of the Revised Penal Code.

FACTS OF THE CASE CONSTITUTING AN

OFFENSE
Finally, I am executing this affidavit to attest to the truth of the foregoing
statements and for the purpose of charging ________________________ in
committing the crime of Physical Injuries against my person penalized under:

Art. 263 Paragraph 4 of the Revised Penal Code

IN WITNESS WHEREOF, I have hereunto set my hand this ___________ of

__________ 2018 at Baguio City, Philippines.

AFFIANT
Valid ID

SUBSCRIBED AND SWORN to before me, this ________ day of

___________2018 at Baguio City, Philippines. I hereby certify that I have
personally examined the herein affiant who personally appeared to me and
acknowledged to me that he read and understood the contents of his affidavit
and that the same are all true and correct of his own personal knowledge.

Administering Officer

Republic of the Philippines)

Done in the City of Baguio ) S.S.

JOINT AFFIDAVIT OF WITNESSES

We, TWO WITNESSES WITH THEIR RESPECTIVE ADDRESSES, respectively,

after having been duly sworn to in accordance with law, depose and state that:

That,

FACTS OF THE CASE HAVING PERSONAL KNOWLEDGED THAT WILL SUPPORT THE
COMPLAINT.

Finally, we are executing this affidavit to attest to the truth of the foregoing
statements for any legal purpose it may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this ___________

of ____________________, 2018 at Baguio City, Philippines.

NAMES AND ID

AFFIANTS

SUBSCRIBED AND SWORN to before me, this ________ day of

__________________, 2018 at Baguio City, Philippines. I hereby certify that I
have personally examined the herein affiants who personally appeared to me and
acknowledged to me that they read and understood the contents of this affidavit
and that the same are all true and correct of their own personal knowledge.

Administering Officer

PLEASE ATTACHED SUPPORTING DUCUMENTARY EVIDENCES EX. MEDICO-LEGAL

CERT. ETC.
As ANNEXES EX. ANNEX “A” ANNEX “B” ETC.