Complaint Affidavit for Filing of BP 22 Case)

COMPLAINT-AFFIDAVIT

I, _____________, Filipino, of legal age, (single / married / widow), and a resident of

_____________, Philippines, after being sworn to in accordance with law, depose and
state:

That I know the person of __Respondent__, who is a resident of _____________,

Philippines;

That sometime in the morning of __date of issue__, at __place of issue__, Philippines,

the said __Respondent__ issued in my favor a __Name of Bank__ Check No.
_____________ in the amount of P_____________ as supposed payment for the loan
accommodation of P_____________, which I have extended to (him/her);

That the said check is drawn against the account of the said __Respondent__ at
__Name of Bank__ with Account No. _____________;

That at the time the said __Respondent__ issued the delivered the said check to me,
(he/she) made the assurance and representation that the said check is a good
check and would be covered by sufficient funds when presented for payment;

However, when the above-mentioned check was deposited, the same was
dishonored and returned by the bank on the ground that the same was drawn
against a "CLOSED ACCOUNT".A true and faithful machine reproduction of the said
check is hereto attached as Annex "____";

As such, I immediately notified said __Respondent__ of the dishonor and return of

the said check and demanded from (him/her) that (he/she) make good the said
check within _____________ (____) days from receipt thereof. A true and faithful
machine reproduction of my demand letter to (him/her) is hereto attached as Annex
"____"

When said __Respondent__ failed to heed my demands, I endorsed the said check to
my legal counsel who immediately sent a formal demand letter through registered
mail with return card on _____________, which was received by the said
__Respondent__ on _____________.As of date however, __Respondent__ has
unjustifiably ignored all these demands to pay the said account and/or to redeem
the said returned check. A true and faithful machine reproduction of my demand
letter to (him/her) is hereto attached as Annex ____"

I am therefore executing this Complaint-Affidavit in support of the charges for

Violation of Batas Pambansa Bilang 22 against the said __Respondent__, who may
be served with subpoena and other processes of this Honorable Office at (his/her)
last known address at _____________, Philippines;

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

_____________, Philippines.

COMPLAINANT

SUBSCRIBED AND SWORN to before me this _____________ at _____________.I hereby

certify that I have examined the Affiant and that I am fully satisfied that (he/she)
has voluntarily executed and understood the contents of (his/her) ComplaintAffidavit.

Administering Officer