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Republic of The Philippines) City of Mandaluyong)

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REPUBLIC OF THE PHILIPPINES)

CITY OF MANDALUYONG )

AFFIDAVIT OF DESISTANCE

I, ___________________________, of legal age, Filipino, and with postal


address at _________________________________________________________
City, Philippines, after having been duly sworn to in accordance with law,
do hereby depose and state:

1. That I am the private-complainant in the case filed against


______________________, for Violation of Batas Pambansa Bilang 22
(3 counts), with Crim Case No. __________________________________
which is now pending before the Metropolitan Trial Court, Branch
__, _______________________ City;

2. That I wish to state that I am no longer interested in pursuing the


above-entitled case to avoid a protracted litigation;

3. With this, I hereby waive and abandon whatever cause/s of


action arising from the same circumstances of the case which I
have against the accused;

4. In view of the foregoing and in the interest of justice, I request this


Honorable Office to dismiss the instant case against the
respondent.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby affixed my signature this ___th day of


____ 2019 at ______________________ City.

____________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____th day of ____ 2019


at ___________________ City. I further certify that I personally examined the
affiant who executed the foregoing Affidavit of Desistance, who attest before me
that all the allegations therein are true and correct of his personal knowledge and
that he voluntarily caused the preparation and fully understood the contents
thereof.

HON. _____________________
Senior Assistant Provincial Prosecutor

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