[Court]

[Region]
[COURT]
[City], [Branch No.]

PEOPLE OF THE PHILIPPINES,

Plaintiff,
Criminal Case No. ________
- versus - For: ___________________

[NAME] ______________,
Accused.
x ---------------------------------------- x

AFFIDAVIT OF DESISTANCE

I, [NAME], [CITIZENSHIP], of legal age, [CIVIL STATUS], and with address at [ADDRESS]
after having been duly sworn to in accordance with law, depose and state:

1. That I am the private complainant in Criminal Case No. __________ against [NAME OF
ACCUSED] for violation of [INDICATE LAW VIOLATED/CRIME] before the [COURT] [CITY]
[BRANCH];
2. That after a careful evaluation of the facts surrounding the case, I have come to realize
that the case arose out of a misapprehension of facts and that the account of the
accused has already been settled even prior to the filing of this case;
3. That I have decided not to pursue the case against the accused considering that under
the circumstances, it will be extremely difficult for the prosecution to secure conviction of
the accused; and
4. That because of the foregoing reasons, I am now desisting in the further prosecution of
the case and will no longer testify against the accused.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of _________ at
______________.

[NAME OF COMPLAINANT]
Affiant
Philippine Passport No. _____
Issued at: ________________
Issued on: _______________

SUBCRIBED AND SWORN TO before me this _________ day of ___________ at __________. I

hereby certify that I have examined the affiant personally and that he voluntarily executed his
affidavit and understood the same.

[NAME OF PROSECUTOR]
PUBLIC PROSECUTOR