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Complaint Affidavit Police Medico Legal
Complaint Affidavit Police Medico Legal
DEPARTMENT OF JUSTICE
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
QUEZON CITY
Angel G. Langit,
Complainant
vs. I.S. No. 123456
For: Rape
Roland Panis y Canin, alias “Rolly”
Respondent.
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COMPLAINT-AFFIDAVIT
committed as follows:
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classmate, Rachel Sy, at St. Claire’s Dormitory,
(d) I was so exhausted that I fell asleep that I did not notice
(f) Rolly barred the door, closed the light, whipped out a
(g) Rolly then forced me to lay on the bed. Out of fear for
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(h)At around 6:30 in the evening, my mother suddenly
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intercourse with me by inserting his penis into my genital
Angel Langit
Complainant/Affiant
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ANNEX “A”
REPUBLIC OF THE PHILIPPINES )
CITY OF QUEZON ) S.S.
SINUMPAANG SALAYSAY
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(e) At around 6 in the evening, someone knocked on our
(f) Rolly barred the door, closed the light, whipped out a
(g) Rolly then forced me to lay on the bed. Out of fear for
Angel G. Langit
Affiant
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the Affiant and I am satisfied that he/she voluntarily
executed and understood his/her statement.
CARDO DALISAY
Administering Officer
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ANNEX “B”