REPUBLIC OF THE PHILIPPINES)

LAOAG CITY )S.C.

AFFIDAVIT - COMPLAINT
I, CARDO DALISAY, of legal age, married, Filipino and a resident of
Brgy. 20, Laoag City, Ilocos Norte, Philippines, after having been sworn to
in accordance with law, hereby depose and state that:

1. I am working as a bartender at ABC Club located at Brgy. 20, Laoag

City, Ilocos Norte;

2. My duty as bartender of ABC club is from six o’clock in the evening

to five o’clock in the following morning, with a weekly rest period on
Sundays;

3. In the evening of August 1, 2018, while I was on duty, Alak Dan, of

legal age, and also a resident of Brgy 20. Laoag City, Ilocos Norte,
came before me and ordered a bottle of gin and a plate of roasted
peanut. After Alak Dan consumed the bottle of gin, he again ordered
another bottle which I immediately gave;

4. When I saw Alak Dan gathering his things to go home I gave him his
bill worth Five Hundred pesos (P500). He told me that he needs to
go home immediately because his wife needs him. I told him that he
needs to pay his bill first before he can go home, however he
refused to pay the same and insisted to go home. I told the security
guards of the Club to restrain him from going outside the premises
of the club until payment from him is made;

5. While I was mixing a liquor drink for another customer Alak Dan,
without any reason, suddenly threw a monoblock chair behind my
back hitting my head, neck, shoulders and back. As a result, I
suffered slight bruises on the said parts that was hit;

6. After that, the security guards immediately restrained him and

forcibly brought him outside the club;

7. The following morning, August 2, 2018, I went to the Barangay Hall

of our barangay to look for Brgy. Captain Digong Duterter to file a
complaint against Alak Dan regarding the incident that transpired on
August 1, 2018 at the ABC Club located within the same barangay;

8. The Lupon Chairman issued a subpoena to Alak Dan to appear

before the Lupon to have a possible amicable settlement with me
regarding the said incident;

9. On August 7, 2018, Alak Dan and I had a confrontation before the

Lupon Chairman regarding the said incident. However, no
conciliation or settlement was reached, hence, the Lupon issued a
 Certification to File Action in favor of me against Alak Dan. A
certified copy of the Certification to File Action is herein attached as
“Annexed A”.

10. I am executing this complaint to attest to the truth of the

foregoing and for the purpose of instituting a complaint for Slight
Physical Injuries under paragraph 2 of Article 266 of the Revised
Penal Code and for Other Purposes or any appropriate case
applicable under the premises against Alak Dan, a resident of Brgy.
20, Laoag City, Ilocos Norte;

IN WITNESS WHEREOF, I have hereunto set my hand this

____________ at Laoag City, Philippines.

CARDO DALISAY
Affiant
Professional Driver’s
License no. A03-
123455-74738

SUBSCIRED AND SWORN to before me this

________________ at Laoag City, Philippines.

Doc. No.100
Page No.50
Book No.XIX
Series of 2018.