REPUBLIC OF THE PHILIPPINES )

Province of Agusan del Nore) S.S.

Butuan City)
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AFFIDAVIT OF DESISTANCE

I, __________, of legal age, nationality, marital status and a residence, after having been
duly sworn in accordance with law, hereby depose and state that:

1. I executed a Compromise Agreement with the ___________________ on

____________ for the payment of __________________________________________;

2. I have decided not to file any criminal action pursuant to the Compromise
Agreement, without prejudice in case they fail to comply with their obligations
therein;

3. I have executed this affidavit in order to attest to the truth of the foregoing
circumstances and that my desistance to pursue said case is of my own free will
and volition and that there was no force, intimidation, coercion or consideration
that took place for me to make such decision; and

4. I have executed this affidavit for any other legal purpose/s this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of _____________,
_________ at the Butuan City.

____________________
Affiant
ID _______________________________

JURAT

SUBSCRIBED AND SWORN to before me this ______ day of _______________, 2019.

Affiant, exhibited to me her VIN as indicated below her name and signature as her
competent evidence of identity.

Doc. No _______;
Page No. ______;
Book No. ______;
Series of _____;