Republic of the Philippines

CITY OF HIMAMAYLAN
-oOo-

People of the Philippines,

Complainant

For:

“ADULTERY”

Vs.

________________________

________________________

x---------------------------------------x

COMPLAINT

The undersigned, Offended Party, hereby accuses (name of

accused), Filipino, (age) years old, (marital status) and a resident of
(address of accused), Negros Occidental, and (name of accused),
Filipino, (age) years old, (marital status) and a resident of (address of
accused), Negros Occidental, charged for the crime of “ADULTERY” or
any other crimes as maybe suggested by the following evidences:

A. Affidavit of:

1. (name of complainant) ---- - (Address)

B. Exhibits:

1. _________________

2. __________________

3. __________________
 CONTRARY TO LAW:

Himamaylan City, Negros Occidental. (date).

(Affiant/Complainant)

1st Endorsement

Respectfully forwarded to the City Prosecutor’s Office, Hall

of Justice, Himamaylan City, Negros Occidental thru
_________________, Himamaaylan City, Negros Occidental,
recommending for prosecution. Please advise this Office of any
action taken on this case for our information.

_______________________