Republic of the Philippines

9th Judicial Region

REGIONAL TRIAL COURT
Branch,
Dipolog City

REPUBLIC OF THE PHILIPPINES,

Complainant,

-versus-

(Name of the accused) Criminal Case No. xxxx-xx

Accused. For: (Criminal Offense)

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

AFFIDAVIT OF DESISTANCE

I, (Name of the Affiant), of legal age, Filipino, single and a resident of

(Affiant’s Complete resident address, after having been duly sworn to in
accordance with law, depose and state:

1. That I am the private complainant of the above-entitled criminal

complaint that is now pending at Branch 9, Dipolog City, Zamboanga
Del Norte;

2. That after having thoroughly considered the facts and circumstances

surrounding the case, I realized that the case filed against the
respondents was merely on account of misunderstanding and
misapprehension of the facts and;
I am requesting for the dismissal of the case against him;

3. That for the record, I am no longer interested in prosecuting this case

and will further desisting there from;

4. I am executing this Affidavit of Desistance without Force, Intimidation,

Undue Influence of threats exerted upon me and to the best of my
knowledge and ability, and realizes that once the charge is dismissed,
the same cannot be refilled, reinstate or revived anymore;

5. Further, I executing this Affidavit of Desistance to attest to the

truthfulness of all the foregoing facts and for the purpose of securing a
dismissal of the above-entitled criminal complaint against the
respondent.

IN WITNESS WHEREOF, I have hereunto set my hand this (nth) day

of (month, year) in Dapitan City, Zamboanga Del Norte, Philippines.

(Name of the Affiant)

Affiant
With Philippine Passport No. (xxxxx)

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 SWORN ATTESTATION

BEFORE ME, appears the person of OGSABADO presenting the above

Affidavit of Desistance, who is personally known to me or identified by me
through competent evidence of identity as defined by the Notarial Rules as
the person who signs the document, and in my presence taken an oath or
affirmation before me as to such document.

WITNESS MY HAND AND SEAL this (nth) day of (month, year) in

Dipolog City.

(Name of the Notary Public)

Notary Public

Doc. No. (xxxxxx);

Page No. (xxxxxx);
Book No. (xxxxxx);
Series of 2022.

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