Republic of the Philippines

Department of Justice
National Prosecution Service
Office of the City Prosecutor
(Venue) City

REPUBLIC OF THE PHILIPPINES)

(VENUE) CITY ) S.S.

Counter Affidavit

I, (Name of Respondent) of legal age, single, resident of (Address)

after having duly sworn to in accordance with the Law do hereby depose

and state;

1. That I am the respondent in the above-entitled case.

2. (Set out the factual allegations to constitute as affirmative and

negative defenses. Establish that not all elements of the crime
imputed have been executed. Make each paragraph as clear,
accurate and concise as possible to aid in painting a complete and
vivid picture of the defense, countering material allegations in the
complaint.)

WHEREFORE, I am respectfully praying before the Office of the City

Prosecutor to (Prayer).

IN TRUTH OF THE FOREGOING, I hereby affix my signature this ___

day of (Month, Year) at (Place).
 (Name of Respondent)
Respondent

SUBSCRIBED and SWORN to before me this ___ day of (Month, Year)

in the City of (Place). I hereby certify that I have examined the affiant and I
am fully convinced that she understood and voluntarily executed the
foregoing statements.

(Name of Prosecutor)
Prosecutor