REPUBLIC OF THE PHILIPPINES

NATIONAL CAPITAL JUDICIAL REGION

METROPOLITAN TRIAL COURT
____________, Branch ___

PEOPLE OF THE PHILIPPINES,

Plaintiff,
Crim Case No.
For: Reckless Imprudence Resulting
-versus- to Serious Physical Injury and
Damage to Property

_______________________________,
Accused.
x-----------------------------------------------------
x

AFFIDAVIT OF DESISTANCE

I, _________________________, of legal age, married, and residing at

_________________________________________, after being duly sworn in
accordance with law, hereby depose and state:

1. I am the Private Complainant in the above-captioned case.

2. After a careful deliberation of the facts surrounding the case, I

found that the initiation of the criminal action was based on a
misapprehension of the facts and circumstances. In truth, the same was
merely a result of a simple misunderstanding and a mistake in the identity
of the person responsible.

3. For these reasons, I am no longer interested in pursuing this

criminal action and shall desist from further prosecuting the case against
the Accused. As such, I request for the dismissal of this case.

4. I am executing this Affidavit to attest to the truth of the

foregoing, of my own free will, and without any undue influence,
intimidation or coercion.

In witness whereof, I execute this Affidavit of Desistance this ___________

in ______________ City.

_____________________________
Affiant

SUBSCRIBED AND SWORN TO before me this

_______________________________. I hereby certify that I have examined the affiant and
I am satisfied that he read and understood the contents of his affidavit, and voluntarily
executed the same.