REPUBLIC OF THE PHILIPPINES)

_________________ ) S.S.

AFFIDAVIT OF DESISTANCE

I, ________________, of legal age, Filipino, with address at _____________________,

after having been sworn in accordance with law, do hereby depose and states that:

1. I am the Complainant in the case docketed as _________________ for

_______________ which is currently pending in the _________________
against __________________________.

2. After a careful review of the antecedent events, facts and circumstances

which precipitated the filing of the aforestated case and upon peaceful
settlement of the case and in the spirit of forgiveness and understanding, I
have hereby unconditionally and irrevocably decided to desist from further
prosecuting the said case and I am now moving for the dismissal of the same
with prejudice.

3. I further attest that I executed this Affidavit voluntarily and that I was neither
forced nor coerced and with full understanding that this desistance will work
as a bar to the further prosecution of the present and/or similar actions.

4. I have nothing further to state.

IN WITNESS WHEREOF, I have hereto affixed my signature on this ___ day of

__________ 2019 at ______________, Philippines.

______________________

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of __________ 2019, in

___________________, Philippines; affiant exhibited to me his _______________ issued at
_______________ valid until _________________.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2019.