Affidavit of Desistance - Template, Sample Form

REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ________________________ )
CITY OR MUNICIPALITY OF ________________________ )S.S.

AFFIDAVIT OF DESISTANCE

I, ________, Filipino, of legal age, with address at ________, after being duly sworn according to law, hereby depose and state that:

1. I am the private complainant in the following case:

Docket No.:________
Case Title: ________
Case Filed: ________

2. I am no longer interested in the further prosecution of the complaint against respondent: ________.

3. The respondent and I have already settled the outstanding obligation.

Attached herewith is the proof that we have settled the same.

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IN WITNESS WHEREOF, I have hereunto affixed my signature this _________ day of ______________________, 20______ at ________________________.

________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of ______________________, 20______ at CITY OR MUNICIPALITY OF ________________________, ________________________

Affiant, ________ personally appeared before me and exhibited to me Postal ID no. ________ which is valid until ________.

Doc. No.: _________;
Page No.: _________;
Book No.: _________;
Series of _________.