AFFIDAVIT OF DESISTANCE

REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

(the persons and circumstances below is fictional, please revise)

I, Juan del la Cruz, of legal age, single, and a resident of # 123 Main St., Malate, Manila, after having duly
sworn to in accordance with law hereby depose and state:

1. I am the complaining witness for Serious Physical Injuries against Jesus Santos in the case entitled "People
of the Philippines versus Jesus Santos", Criminal Case No. 12345, Metropolitan Trial Court, Branch No. 11, City of
Manila.

2. After my sober and soul searching assessment and analysis of the incident, I have realized that because I was
not wearing my eyeglasses and it was dark, I can not point out, without a doubt the accused or any other person/s
who inflicted harm against me.

3. Since I could not state with certainty and without doubt the liability of Jesus Santos, in fairness to him, I am
permanently withdrawing my complaint against him. I clear him of whatever responsibility or liability to me.

4. I hereby inform the City Prosecutor of Manila that I am withdrawing my complaint for Serious Physical
Injuries in Criminal Case No. 12345 entitled "People of the Philippines versus Jesus Santos", Metropolitan Trial
Court, Branch No. 11, City of Manila.

5. I likewise request the Metropolitan Trial Court, Branch No. 11, City of Manila to dismiss with prejudice the
said criminal case.

IN WITNESS WHEREOF, I hereby set my hand this __ day of September 20__ at the City of Manila.

Juan de la Cruz
Complaining Witness

SUBSCRIBED AND SWORN to before me this 22nd day of January 20__ at the City of Manila, Philippines.

Romeo Abad
Public Prosecutor