(Complaint Affidavit for Filing of BP 22 Case)

COMPLAINT-AFFIDAVIT

I, _____________, Filipino, of legal age, (single / married

/ widow), and a resident of _____________, Philippines,
after being sworn to in accordance with law,
depose and state:

That I know the person of __Respondent__, who is a

resident of _____________, Philippines;

That sometime in the morning of __date of issue__,

at __place of issue__, Philippines, the said
__Respondent__ issued in my favor a __Name of
Bank__ Check No. _____________ in the amount of
P_____________ as supposed payment for the loan
accommodation of P_____________, which I have
extended to (him/her);

That the said check is drawn against the account

of the said __Respondent__ at __Name of Bank__
with Account No. _____________;

That at the time the said __Respondent__ issued the

delivered the said check to me, (he/she) made the
assurance and representation that the said
check is a good check and would be covered by
sufficient funds when presented for payment;
However, when the above-mentioned check was
deposited, the same was dishonored and returned
by the bank on the ground that the same was
drawn against a "CLOSED ACCOUNT".A true and
faithful machine reproduction of the said check
is hereto attached as Annex "____";

As such, I immediately notified said __Respondent__

of the dishonor and return of the said check
and demanded from (him/her) that (he/she) make
good the said check within _____________ (____) days
from receipt thereof. A true and faithful machine
reproduction of my demand letter to (him/her) is
hereto attached as Annex "____"

When said __Respondent__ failed to heed my

demands, I endorsed the said check to my legal
counsel who immediately sent a formal demand
letter through registered mail with return card
on _____________, which was received by the said
__Respondent__ on _____________.As of date however,
__Respondent__ has unjustifiably ignored all these
demands to pay the said account and/or to
redeem the said returned check. A true and
faithful machine reproduction of my demand
letter to (him/her) is hereto attached as Annex
____"

I am therefore executing this Complaint-Affidavit

in support of the charges for Violation of Batas
Pambansa Bilang 22 against the said __Respondent__,
who may be served with subpoena and other
processes of this Honorable Office at (his/her) last
known address at _____________, Philippines;

IN WITNESS WHEREOF, I have hereunto set my hand

this _____________ at _____________, Philippines.

COMPLAINANT

SUBSCRIBED AND SWORN to before me this

_____________ at _____________.I hereby certify that I
have examined the Affiant and that I am fully
satisfied that (he/she) has voluntarily executed
and understood the contents of (his/her)
Complaint-Affidavit.

Administering Officer