REPUBLIC OF THE PHILIPPINES )

PROVINCE OF MISAMIS OCCIDENTAL ) SS.

_________________________ )

AFFIDAVIT OF DESISTANCE

I, ________________, Filipino, of legal age, single and a resident of

________________________ after having been duly sworn to in accordance with law, hereby
depose and say, that:

1. I am the private complainant for physical injury against ________________, Filipino,

of legal age, married and a resident of _________________________________;

2. After ____________ and I had a recent conversation regarding the above incident,
both of us decided to settle the problem amicably by entering into a Compromise
Agreement, a copy of which is herein attached as Annex “A” hereof;

3. In view of foregoing, I hereby manifest that I now completely and absolutely

exonerate ____________ from any liability in connection with the above-mentioned
incident and that I am no longer interested to institute a formal complaint for the
same.

4. I am executing this affidavit of my own free will and volition, signifying my intention
to desist from prosecuting ____________, hereby waiving all rights and claims due
to me arising from the said incident, now and hereafter;

5. I fully understand the legal consequences of this Affidavit of Desistance and do

hereby attest to the truth of the declarations herein;

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of May 2022, at
___________________, ____________, Philippines.

____________
Affiant

SUBCRIBED AND SWORN TO before me this this ___ day of ______, 2022 in

_____________ ____________, Philippines.
Doc. No. ______;
Page No. ______;
Book No. _______;
Series of 2022.