Sample of Affidavit of

Complaint

Republic of the Philippines )

____________, ________ )
s.s.
x- - - - - - - - - - - - - - - - - - - -
- -x

AFFIDAVIT OF COMPLAINT
 The UNDERSIGNED,
_______________________
___, accuses _________, of
_____________, committed
as follows, to wit:

That on or about
_________, at about
_____________ in the
_________________,
______________,
Philippines, the said
accused did then and
there willfully, unlawfully,
feloniously, and by means
of _____________,
committed
_____________, upon the
undersigned directly by
overt acts to wit: (state
the details
how the crime was
committed).
The undersigned executed
this affidavit to attest the
truthfulness of the foregoing
facts and to support the
filing of Criminal Cases
against
_______________________
________ for violations of
_______________________
_.

___________, this _____

day of __________, ____.
_______________________
_____

Offended Party

SUBSCRIBED AND
SWORN to before me this
___ day of _______ at
_______________. I
HEREBY CERTIFY that I
have personally examined
the herein
offended party and I am
satisfied that they
voluntarily executed and
understood their
given affidavit.

_______________________
__
Judge

WITNESSES:
_______________________
___

_______________________
___
Sample of Affidavit of
Complaint

Republic of the Philippines )

____________, ________ )
s.s.
x- - - - - - - - - - - - - - - - - - - -
- -x

AFFIDAVIT OF COMPLAINT

The UNDERSIGNED,
_______________________
___, accuses _________, of
_____________, committed
as follows, to wit:

That on or about
_________, at about
_____________ in the
_________________,
______________,
Philippines, the said
accused did then and
there willfully, unlawfully,
feloniously, and by means
of _____________,
committed
_____________, upon the
undersigned directly by
overt acts to wit: (state
the details
how the crime was
committed).
The undersigned executed
this affidavit to attest the
truthfulness of the foregoing
facts and to support the
filing of Criminal Cases
against
_______________________
________ for violations of
_______________________
_.

___________, this _____

day of __________, ____.
_______________________
_____

Offended Party

SUBSCRIBED AND
SWORN to before me this
___ day of _______ at
_______________. I
HEREBY CERTIFY that I
have personally examined
the herein
offended party and I am
satisfied that they
voluntarily executed and
understood their
given affidavit.

_______________________
__
Judge

WITNESSES:
_______________________
___

_______________________
___
COMPLAINT SHEET

1. Name of COMPLAINANT/S (nagsusumbong) Address and Tel/CelNo/s.

_______________________________________ _______________________________________

_______________________________________ _______________________________________

2. Name of Accused (isinumbong)

_______________________________________

_______________________________________

3. Nature of the acts/ complained (nature of the offense)

_____________________________________________________________________________________

4. WHEN AND WHERE THE COMMITTED (Kailan at Saan nangyari offense)

5. Name of Offended Party (pangalan ng biktima)

_____________________________________________________________________________________

6. Brief Narration of Facts (maiksing salaysay ng pangyayari)

_____________________________________________________________________________________