AFFIDAVIT OF DESISTANCE

REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

(the persons and circumstances below is fictional, please revise)

I, Juan del la Cruz, of legal age, single, and a resident of # 123 Main St., Malate, Manila,
after having duly sworn to in accordance with law hereby depose and state:

1. I am the complaining witness for Serious Physical Injuries against Jesus Santos in the case
entitled "People of the Philippines versus Jesus Santos", Criminal Case No. 12345, Metropolitan
Trial Court, Branch No. 11, City of Manila.

2. After my sober and soul searching assessment and analysis of the incident, I have realized
that because I was not wearing my eyeglasses and it was dark, I can not point out, without a
doubt the accused or any other person/s who inflicted harm against me.

3. Since I could not state with certainty and without doubt the liability of Jesus Santos, in
fairness to him, I am permanently withdrawing my complaint against him. I clear him of whatever
responsibility or liability to me.

4. I hereby inform the City Prosecutor of Manila that I am withdrawing my complaint for
Serious Physical Injuries in Criminal Case No. 12345 entitled "People of the Philippines versus
Jesus Santos", Metropolitan Trial Court, Branch No. 11, City of Manila.

5. I likewise request the Metropolitan Trial Court, Branch No. 11, City of Manila to dismiss
with prejudice the said criminal case.

IN WITNESS WHEREOF, I hereby set my hand this __ day of September 20__ at the City of
Manila.
 Juan de la Cruz
Complaining Witness

SUBSCRIBED AND SWORN to before me this 22nd day of January 20__ at the City of Manila,
Philippines.

Romeo Abad
Public Prosecutor

REVOCATION OF SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

WHEREAS, I, ANNE KURTIS, of legal age, Filipino, single and a resident of 1122 Antipolo Street, Valenzuela, Makati
City, by a certain public instrument made and executed in Makati City on June 28, 2013 before Notary Public BONG
NABARO of Makati City andregistered as Document No. 1; Page No. 2, Book No. 3; Series of 2013 in his
notarial register, did name, constitute and appoint BAYS GANDA, a resident of 3344 Antipolo Street, Valenzuela,
Makati City as my true and lawful ATTORNEY-IN-FACT, for the purpose and with powers mentioned in said instrument;

WHEREAS, the said public instrument or Power of Attorney, was never registered with the Register of Deeds for the
Province of Bataan;

NOW, THEREFORE, I, ANNE KURTIS, by virtue of these presents hereby REVOKE,ANNUL and VOID the said
power of attorney and all powers and authority therein or thereby given or granted or intended to be given or granted
to said BAYS GANDA;

FURTHER, I, ANNE KURTIS, hereby revoke all Special Powers of Attorney that I may have executed before the
date of this Deed with respect to my property registered under Transfer Certificate of Title No. 123456 of the Register of
Deeds for the City of Makati.

ANNE KURTIS
Principal

Signed in the presence of:

_____________________________ ______________________________
 [Witness 1] [Witness 2]

(ACKNOWLEDGMENT)

SPECIAL POWER OF ATTORNEY

I _______________________, hereby name, appoint and constitute _________________________ to be my true and lawful
attorney, to act on my behalf and in my name, to execute and perform all or any of the following acts, deeds, matters and
things, in connection with _________________________, to wit:

(ENUMERATE POWERS TO BE CONFERRED)

HEREBY GIVING AND GRANTING unto our said attorney full powers and authority to do and perform all and every act
requisite or necessary to carry into effect the foregoing powers, as fully to all intents and purposes as I might or could
lawfully do if personally present, with full power of substitution and revocation, and hereby ratifying and confirming all that
my said attorney or his substitute shall lawfully do or cause to be done by virtue hereof.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of _________ 2001, in __________________.

____________________________

Conforme:

(Signature of Appointee)

Signed in the presence of:

__________________________ __________________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

MAKATI, METRO MANILA ) S.S.

BEFORE ME , a Notary Public for and in the __________, this ___________________, personally appeared the following:

Name CTC No. Place Date

known to me and to me known to be the same person/s who executed the foregoing General Power of Attorney consisting of
__ pages including the page on which this Acknowledgment is written, and who acknowledged to me that the same is their
free and voluntary act and deed.
 IN WITNESS WHEREOF, I have placed my hand and seal on the date and at the place first above-written.

Doc. No.:
Page No.:
Book No.:
Series of _____.