(Affidavit of Desistance Violation of BP 22)

Republic of the Philippines)

Province of _________________) S.S.
City/Municipality of____________)
x––––––––––x

AFFIDAVIT OF DESISTANCE

I,___________, of legal age, Filipino and a resident of Bacolod City, after having
been duly sworn in accordance with law, hereby depose and say:

1.That I am the private complainant in the Criminal Cases

Nos.____________to____________entitled “People of the Philippines
vs._____________”; for Violation of Batas Pambansa Bilang 22 pending before
the Municipal Trial Court, Branch______, ____________City, Philippines.

2.In this regard, the accused___________has already paid in full the amount
represented by the checks subject of the above-mentioned cases, to with:
Criminal Case No.Check No.Amount

3.That in view of the payment in full by the accused, I would like to manifest that I
am no longer interested in the prosecution of the aforementioned criminal cases
and I am respectfully requesting the Honorable Public Prosecutor to move for the
dismissal of the aforementioned cases against the accused.

IN WITNESS WHEREOF, I have hereunto set my hand this_____________

at___________, Philippines.

AFFIANT

(JURAT)