Republic of the Philippines )

Municipality of ___________)s.s.
x-- - - - - - - - - - - - - - - - - - - - x

Complaint Affidavit

I, ____________________, after having been sworn to in accordance with

law, hereby depose and state:

1. That I am charging ____________, Station Commander,

______________Station of Violation of Rule 21, Section 2(c)(7)(e) of PNP
Memorandum Circular No. 2007-001 for Dishonesty in ________________,
committed as follows:

2. That on __________, _____________ issued a Memorandum for

_______________. Copy of the said Memorandum is hereby attached as
ANNEX A;

3. That on the sad Memorandum, ____________stated that there were no

reports of existence of illegal gambling activities which lead into successful
and peaceful celebration until the duration of the event;

4. That the said Memorandum contains false information affecting public

interest;

5. That the truth of the matter, there was an operation of the illegal activities
penalized under our Revised Penal Code, from last week of __________at
the frontage of the _________;

6. That the illegal activities _________ was not apprehended and ignored by
the Members of the Police Unit of __________headed by _______;

7. That the said illegal activities were personally witness by ________ and
_________, who have executed their sworn affidavits that confirming the
same. Copy of the said affidavits is hereby attached as ANNEX B and
series;
 8. That I executed this to attest to the foregoing and request the Honorable
Chief PNP to charge __________with Violation of Rule 21, Section 2(c)(7)(e)
of PNP Memorandum Circular No. 2007-001 for Dishonesty in
___________.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day

of ____________hereat _______________________.

ANDRES BONIFACIO
(Affiant)
________________

SUSCRIBED AND SWORN to before me this ______ of _________at

______________. I further certify that I personally examined the herein affiant
and I am convinced that he voluntarily executed the foregoing affidavit and he
fully understood the contents thereof.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2017