Republic of the Philippines)

Davao City )ss.

x - - - - - - - - - - - - - - - - - - - - - -/

AFFIDAVIT OF DESISTANCE

I, __________________, of legal age, Filipino, and a resident of

____________________________, Philippines, under the law depose and state that:

1. On 17 December 2023, an incident occurred at _________________________

Davao City involving Mr. _______________________.

2. I have since realized and understood that Mr. ___________________ did not
commit any criminal act and that the whole incident was a mere misunderstanding. Hence, I am
no longer interested in testifying against Mr. ____________________ and in pursuing any
criminal case in connection with the incident that occurred on 17 December 2023.

3. For said reason, I am permanently withdrawing any complaint against Mr.

____________________. I also hereby WAIVE, FORFEIT, and RELINQUISH any and ALL
rights, claims, and interest pertaining to and arising out of the said incident.

4. Moreover, I hereby undertake to cause the withdrawal of all complaints filed

against him and I shall execute the necessary documents needed for its withdrawal.

5. I execute this Affidavit out of my own volition without being forced or intimated
to execute this document.

6. The aforesaid statements have been fully read and translated to me in Tagalog and
Cebuano dialects, which are dialects I understand.

7. I execute this Affidavit of Desistance to attest to the truth of the foregoing, to

cause the dismissal of any complaint, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

___________________ at Davao City, Philippines.

________________________

SUBSCRIBED AND SWORN to before me this __________________ at Davao City,

Philippines. I HEREBY CERTIFY that I have personally examined the affiant and I am satisfied
that she understood her affidavit and executed the same of her own free and voluntary act and
deed.

SUBSCRIBING OFFICER