Resolution N o.

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General Instructions for the Im plem entation of R esolution N o. 9476 as am ended

[Complaint-affidavit template to guide potential complainants in the drafting of their complaints]

Annex "E"

Republic of the Philippines )

City o f _______________ ) S.S.

C O M P L A IN T

I, (name of complainant) , of legal age, Filipino, residing at (address of

the complainant’) , hereby accuses (name of respondent/s') of violating
(offense and provision of law alleged to have been violated) , committed as
follows:

That on or about (date and time) , in (place where the offense was
committed) , the said accused (description of the unlawful acts, omissions,
activities that constitute the offense charged) .

That the said act/omission was likewise witnessed by (names of

witnesses)_____________, whose testimonies, in the form of sworn statements,
are attached to this complaint as Annexes "__" and "___

I have hereunto set my hand this _____ o f _________________, 2013, at the

City o f ____________________.

(Signature of Complainant)
[Name o f Complainant]
COMPLAINANT

SUBSCRIBED AND SWORN to before me, th is____day o f ____________ ,

2013 by (name of affiant) who exhibited to me his/her (competent evidence
of identity) with num ber____________, issued at (issuing agency and its
location) , Philippines on (date of issue) , with date of expiry o n __________ .

NOTARY PUBLIC
Doc No.
Page No.
Book No.
Series of 2013.