Republic of the Philippines)

Province of_______________)S.S.
City/Municipality of____________) 
x---------x
AFFIDAVIT OF DESISTANCE
I,____________,Filipino, single, with residence__________, under oath allege:
1.That I am the complainant in Criminal Case No.__________for alleged "RAPE" against
accused___________, which case is pending before the Regional Trial Court, Branch______,
_____________City, Philippines;
2.That I signed the aforesaid complaint against accused__________against my will, my signature in the
complaint having been obtained thru force, violence and intimidation done to me by my parents;
 
3.There is no truth to the allegations contained in my sworn statement executed by me against my will
on___________at____________, taken by____________. There was no force, violence or intimidation
done against me by said accused___________. I was not forced by him to submit to his desires. It was
all in accordance with my own will, volition and consent that I went personally to him because we love
each other and I agree and consent to live with him as my husband;
4.I therefore respectfully request that the above-mentioned case filed against said___________be
dismissed as in fact I now withdraw my complaint against him and I further manifest under oath that I
am now desisting from testifying against him in Court or in any other government entity or
agency in connection with the said criminal case.
IN WITNESS WHEREOF, I have hereunto set my hand this___________at____________,
Philippines.
AFFIANT
(JURAT)
REPUBLIC OF THE PHILIPPINES }
QUEZON CITY  }  S.S.

AFFIDAVIT OF VEHICULAR ACCIDENT

I, _______________________, (civil status), of legal age, a resident of ________________________________
______ after being sworn in accordance with law, hereby depose and say:
That I am the holder of a Professional Drivers License No. ____________ issued by the LTO of
__________________________ and valid until ______________________;
That I am an employee of Valiant Distribution, Inc/Mckenzie Distribution Co. Inc. and as such I am assigned a
car more particularly described as follows:
Make:
Year Model
Plate No.
CR No.
OR No.

That on ____________________, at around ____________(time), more or less, I wasdriving the

aforementioned vehicle on my way to __________________ from ____________________;
That (make a brief statement of the accident)

That the aforementioned situation was an accident beyond my control after exercising extraordinary care and
diligence to safety;

That the same extraordinary care and diligence was exercised when I took control of the situation by immediately
applying the brakes and preventing a more fatal vehicular accident.

That I execute this AFFIDAVIT to attest to the veracity of the facts stated herein and for insurance claims
purposes.
Done this _____________ 2012 at Quezon City.
  _______________________________________
Affiant
CTC. No. _______________________
Issued on _______________________________
Issued at _______________________________

Subscribed and sworn to before me this ___________ day of _____________2012 at Quezon

City, Philippines.

Doc. No. _______ Notary Public

Page No. _______
Book No. ______
Series of 2012.

AFFIDAVIT OF DESISTANCE

REPUBLIC OF THE PHILIPPINES)

CITY OF PASAY )  S.S.

I, Luis Alejandro , of legal age, single, and a resident of # 123 Main St., Bonifacio, Pasay City, after having duly sworn to
in accordance with law hereby depose and state:

I am the complaining witness for Reckless Imprudence resulting to Less Serious Physical Injuries against Juan Madrid in
the case entitled "People of the Philippines versus Juan Madrid", Criminal Case No. 12345, Municipal Trial Court, Branch
No.11, City of Pasay.

After my sober and soul searching assessment and analysis of the incident, I have realized that because I was not wearing
my eyeglasses and it was dark, I cannot point out, without a doubt the accused or any other person/s who inflicted harm
against me.

Since I could not state with certainty and without doubt the liability of Jesus Santos, in fairness to him, I am permanently
withdrawing my complaint against him. I clear him of whatever responsibility or liability to me.

I hereby inform the City Prosecutor of Pasay that I am withdrawing my complaint for Reckless Imprudence resulting to
Less Serious Physical Injuries in Criminal Case No. 12345 entitled "People of the Philippines versus Jesus Madrid",
Municipal Trial Court, Branch No.11, City of Pasay.