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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 Witness Republic of the Philippines ) ____________, ________ ) s.s. x- - - - - - - - - - - - - - - - - - - - - -x AFFIDAVIT OF WITNESS I, ________________________, age, civil status, resident of __________________________, _________, after having sworn in accordance with law, do hereby depose and state THAT: 1. I was present and personally saw that accused, __________, committed the crime of ___________________________ against the victim _______________; 2. 3. 04. (State other circumstances and the relation either to the victim or accused or both); (State the details of the acts committed by the accused against the victim. (State the acts done by the witness and the reason thereof);

I executed this affidavit to attest the truthfulness of the foregoing facts and to support the filing of Criminal Cases against _______________________________ for violations of ________________________. AFFIANTS SAYETH NAUGHT. IN WITNESS WHEREOF, I hereunto affixed my signature this ___day of ____________ at ____________, _______________. _______________________________ Affiant SUBSCRIBED AND SWORN to before me this ___ day of _______ at _______________. I HEREBY CERTIFY that I have personally examined the herein affiants and I am satisfied that they voluntarily executed and understood their given affidavit. _____________________ Notary Public

To this date . 5. Filipino citizen and a resident of Vamenta. Philippines. 2009 in Cagayan de Oro City.00 and the mortgage of Spouses Bacsarpa’s real property. I acted within the scope of my authority in obtaining a loan amounting to Php5. the said loan and the documents I executed in behalf of the Spouses were valid. Hence. no forgery. I agreed to become Spouses Bacsarpas’ attorney-in-fact. As the attorney-in-fact of the Spouses Bacsarpas. Dona Aniqa went to my house and told me that she and her husband are planning to put up a business. Truth to tell. As evidenced by their duly notarized Special Power of Attorney copy thereof is attached here as Annex A. I deny the allegation that I misrepresented myself to be Dona Aniqa Macarambon-Bacsarpa [hereinafter “Dona Aniqa”]. 3. 6.S COUNTER-AFFIDAVIT Caption I. in relation to Article 172 and Article 48 of the Revised Penal code. 1 In my capacity as such. AZRIFA MAMUTUK Assistant City Prosecutor Cagayan de Oro City Copy furnished by Registered mail: Vincy Jane Polinar 1 Exhibit “1” Exhibit “1” 2 . 2. which title I delivered to the bank. Therefore. regular and legal. Spouses Bacsarpas have not cancelled. revoked or superseded the said Special Power of Attorney. amounting to estafa ever transpired . of legal age. falsification. the truth being that I have been appointed as the attorney-in-fact of Spouses Bacsarpas. I have hereunto set my hand this 15th day of December. BOD ATTESTATION APIPA G.000. they were eventually turned over to the Spouses on the same day as evidenced by their acknowledgment receipt. I am executing this Counter-Affidavit to attest to the truth that I DID NOT COMMIT THE CRIME OF ESTAFA in whatever form as erroneously and maliciously alleged by the Complainant. Apipa G. they requested me to apply for a loan in their behalf.The place where the affidavit is executed REPUBLIC OF THE PHILIPPINES ) CITY OF CAGAYAN DE ORO ) S. 7. 08282 for the crime of Estafa thru Falsification of public documents under Article 315 paragraph 2. Cagayan de Oro City. Stated differently. GURO Affiant NAME AND SIGNATURE OF AFFIANT JURAT SUBSCRIBED AND SWORN TO before me this 15th day of December. Carmen. T-178439 for purposes of constituting a mortgage thereon by executing a Deed of Real Estate Mortgage. IN WITNESS WHEREOF. As a result. I signed and delivered documents pertinent to the transactions in their behalf. I did not commit the crime of forgery. All told. 4. the Spouses delivered to me the owner’s duplicate copy of TCT No. 2009 at Cagayan de Oro City. Spouses Bacsarpa also wanted to go to the US for a two (2) months vacation. I remain to be their duly appointed attorney-in-fact. 2007. Guro. Since Spouses Bacsarpa were in need of money for their business and also for their trip abroad. hence. a copy thereof is attached here as Annex B 2 4. I am the accused in IS no. The antecedental facts that led to this case can be narrated in this manner : On October 1. while I categorically received the proceeds of the said loan from the bank. after having been sworn to in accordance with law hereby depose and state that: PERSONAL 1. while I may have signed the questioned documents in their behalf. I was expressly authorized to sign all documents pertinent to said loan. I hereby certify that I have personally examined the affiant and that I am fully convinced that she had voluntarily executed her counter-affidavit and that he has read and understood the contents thereof.000. Philippines. 8.