REPUBLIC OF THE PHILIPPINES)

CITY OF ___________ )S. S.

AFFIDAVIT OF DESISTANCE

I, ______________________________ of legal age, with office address at

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

1. I am the private complainant in the case docketed as Criminal Case No.

_________________ entitled “People of the Philippines versus ________________________”
now pending before the Regional Trial Court of Makati Branch ____.

2. After the case was filed, both parties agreed to settle the civil aspect of the case.

3. In view of the settlement, I am no longer interested in prosecuting my complaint

against _____________________ .

4. I am executing this Affidavit of Desistance free from any force, intimidation,

violence; undue influence or threats and the contents of the same refer only to the truth.

FURTHER AFFIANT SAYETH NOT.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of November
2014 in the City of _________________.

________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___day of November 2014 in the City
of __________________ by Affiant.

_________________________
PROSECUTOR

I hereby certify that I personally examined the affiant and that I am satisfied that he
understood and voluntarily executed the foregoing Affidavit.

_________________________
PROSECUTOR