Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE OF THE PROVINCIAL PROSECUTOR
City of Malolos, Bulacan

_______________________,
Complainant,

-versus- NPS DOCKET NO. ______________

_______________________,
Respondents.
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SUPPLEMENTAL COMPLAINT-AFFIDAVIT
Complainant, by herself, to this Honorable Office, most respectfully aver:

1. On _____________, I filed a complaint before this Honorable Office

docketed as NPS DOCKET NO. ________________, entitled
“_____________, versus ________________” for Falsification and Use
of Public Document;

2. On the Investigation Data Form and in the case title appearing on the face
of the Complaint-Affidavit, the name of one of the respondents is
indicated as ______________ instead of ___________________;

3. Perusal of the contents of the complaint will reveal that one of the
persons against whom the case is being filed is ________________ and
not __________________;

4. Complainant, being a senior citizen, is often plagued by poor eyesight,

which is the reason that the error of one of the respondents name was not
immediately noticed and thought that the name of
________________________ was the one indicated on the Investigation
Data Form and to the case title appearing on the face of the Complaint-
Affidavit;

5. All the allegations in the body of the complaint are true and correct;

6. Thus, she respectfully requests this Honorable Office that the name of
______________________ indicated in the Investigation Data Form and
to the case title appearing in the face of the complaint-affidavit be
removed and changed to _____________________, instead;
 2

WHEREFORE, premises considered, complainant respectfully requests

this Honorable Office that the name of ___________________ indicated in the
Investigation Data Form and to the case title appearing in the face of the
complaint-affidavit be removed and changed to ______________, instead.

Other reliefs just and equitable are also prayed for.

City of Malolos, Bulacan, ________________.

_________________________
Complainant
NOTICE AND COPY FURNISHED:

__________________
___________________

____________________
____________________

Explanation:

Copy of this Supplemental Affidavit was served upon the adverse parties
by registered mail, instead of personally, due to time and distance constraints
and lack of personnel to effect personal service.

__________________________
Complainant