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REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ________ )
CITY OR MUNICIPALITY OF ________ ) S.S.
AFFIDAVIT OF DESISTANCE
I, ________, Filipino, of legal age, single/married, with residence and postal address at ________, after having been duly sworn to in accordance with law, do hereby depose and state THAT:
§ 1. Capacity of Affiant. I am the private complainant in the case more particularly described below, and I am executing this Affidavit with full knowledge of the nature and consequences of my act:
Docket/Case No.: ________
Case Title: ________
Nature of the Case/Offense Charged: ________
Pending Before: ________
Date Case was Filed: ________
§ 2. Withdrawal of Interest. After serious and mature deliberation, and upon a full understanding of the circumstances surrounding the said case, I have decided that I am no longer interested in the further prosecution of the complaint against the respondent/accused, ________.
§ 3. Amicable Settlement. The respondent/accused and I have voluntarily entered into an amicable settlement, and the outstanding obligation and all matters subject of the said case have been fully and completely settled to my entire satisfaction in the amount of ________ (where applicable). A copy of the proof of such settlement is attached hereto and made an integral part hereof as Annex “A”.
§ 4. Misapprehension of Facts. I have come to realize that the filing of the said complaint arose from a misunderstanding and/or misapprehension of facts between the respondent/accused and myself, and I am now convinced that no useful purpose will be served by the continuation of the said case.
§ 6. Prayer for Dismissal. In view of the foregoing, and considering that the civil and other aspects of the case have been amicably settled, it is respectfully prayed that the preliminary investigation and/or the case against the respondent/accused be DISMISSED with finality, and that I be excused from further attending any proceeding in relation thereto.
IN WITNESS WHEREOF, I have hereunto set my hand this ________ day of ________, 20____ at ________, Philippines.
________
Affiant
SUBSCRIBED AND SWORN TO before me this ________ day of ________, 20____ at the City/Municipality of ________, ________, affiant exhibiting to me competent evidence of identity, namely Postal ID No. ________, valid until ________, issued at/by ________, and I am satisfied that the said affiant is the same person who personally appeared before me, voluntarily executed and understood the contents of the foregoing Affidavit.
________
NOTARY PUBLIC
Doc. No.: ________;
Page No.: ________;
Book No.: ________;
Series of ________.
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