Republic of the Philippines )

Province of Isabela
) S. S.
City of Ilagan
)
x--------------------------------x
AFFIDAVIT OF DESISTANCE
I, ________________(Complaining Witness)____________, Filipino, of legal age,
[single]/[married to _________(name of spouse)_________], and a resident of
___________________(address of affiant)_______________, after having been duly sworn in
accordance with law, hereby depose and state:
1. That I am the complainant in Criminal Case No. ______________, entitled "People of
the Philippines versus ______________", for alleged RAPE against accused
_______________________, which case is pending before the Regional Trial Court,
Branch No. _______, _______________ City, Philippines;
2. That I signed the aforesaid complaint against accused _____________________
against my will;
3. That my grandparents will cut-off my monthly allowances if I do not sign the
complaint;
4. There is no truth to the allegations contained in my sworn statement executed by me
that states:
______________________________________;
_______________________________________;
5. I hereby inform the Public Prosecutor of _______________ that I am withdrawing my
complaint for __________ in Criminal Case No. _________ entitled "People of the
Philippines versus ______________", Regional Trial Court, Branch No.__,
_________City, Philippines.
6. I likewise request the Regional Trial Court, Branch No.__, _____________City,
Philippines, to dismiss with prejudice the said criminal case.

IN WITNESS WHEREOF, I have hereunto set my hands this ___ day of ________,
2014 at Ilagan City, Isabela.

SUBSCRIBED AND SWORN to before me this ___ day of January, 2013 at Ilagan
City, Isabela.

Doc. No. ___

Page No. ___
Book No. ___
Series of 2013.