REPUBLIC OF THE PHILIPPINES

OFFICE OF THE _______________________

Hall of Justice, ________________

_____________________________,
Complainant,
I.S. No.:
-versus- For: ______________

_____________________________,
Respondent.

COMPLAINT AFFIDAVIT

I, ____________________ (herafter referred to as Complainant) is of legal age, married,

Filipino and, for purposes of this criminal complaint, with postal address at
, after being sworn according to law, depose and say that:

1. Respondent __________________ (hereafter referred to as Respondent) is of legal age,

married, Filipino and with address at ________________________________________,
where summons and notices may be served.

2. This is a criminal complaint for ____________________________________________

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________.

3. ______________________________________________________________________
______________________________________________________________________.

4. For the record, and to form part hereof, by incorporation and reference, attached hereto
are copies of the following supporting documents, to wit:

WHEREFORE, premises considered, it is respectfully prayed that after notice and hearing
the respondent be indicted for __________________________________ to protect/preserve the
right/interest of the complainant to recover his claim of _____________________________,
plus exemplary damages of ______________, moral damages of _______________, attorney’s
fees of __________________________, and costs of suit.