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AFFIDAVIT OF DESISTANCE
 
REPUBLIC OF THE PHILIPPINES)
__________________________ ) S.S.
 
        I, _______________________________, of legal age, single, Filipino and a resident
of _________________________________, after having duly sworn to in accordance
with law hereby depose and state:
 
        1. I am the complainant in the case
entitled "____________________________________,” docketed as Criminal Case no.
_____________________ pending
before_____________________________________________________
 
        2. The accused has proposed to settle the civil aspect of the case and I have agreed
to her proposal to pay by way of indemnity, the total amount of EIGHTY THOUSAND
PESOS (Php 80,000.00).

       3. I hereby inform the City Prosecutor of ____________________ that I am

withdrawing my complaint for violation of Batas Pambansa Blg. 22 in Criminal Case
Nos. ______________________________.
 
        4. I likewise request that the
_____________________________________________________ provisionally dismiss
the said criminal case subject to revival in case of failure to comply with the terms of the
Compromise Agreement executed in connection herewith.
 
IN WITNESS WHEREOF, I hereby set my hand this __ day of
       
_________________________ at _________________________
 
 
 
_____________________________
Affiant-Complainant
 
 
SUBSCRIBED AND SWORN to before me this_____________________ at
____________________________.