REPUBLIC OF THE PHILIPPINES) ) S.S.

AFFIDAVIT-COMPLAINT I, ____________________, of legal age, Filipino, married with business address at _________________________ depose and state: 1. That I am the Manager and duly authorized representative of ____________________________ for brevity, a corporation duly organized and existing under the Philippine laws, with principal address at __________________________ . A photocopy of the Secretarys Certificate authorizing Cesario Cruz to file the above-captioned complaint is hereto attached as Annex A and made an integral part hereof. 2. That after having duly sworn to in accordance with law, I do hereby accuse ________________________, driver-collector of _____________________, of legal age with residential address at ________________________________, where he can be served with legal processes of the complex crime of ESTAFA WITH ABUSE OF CONFIDENCE under the Revised Penal Code. 3. That the submission and falsification of the ________________, sales, invoices and sales reports from January 2008 to September 2009 was committed in ________________ and the misappropriation of the cash sales of the sold _____________ products was committed by the respondent in the following manner to wit: 3.1 That I am the _______________ ___________________ since _________. of

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That ________________________ was employed by _________ since 20__ as driver and collector. That respondent received ___________ for delivery and sales to customers in ___________ City since 20__. That it is incumbent upon him to return unsold products to Plaintiff Corporation in its office in _________________. That on _____________, 20__, I received verbal reports from ____________________, Branch (Position) about the short/under on floor stock in the daily report on full cylinder

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floor stock. Photocopies of the Sworn Affidavit of _________________ is hereto attached as Annex B made integral part hereof. 3.5 Acting on the Information that I received from __________________________, I informed the Management and soon an audit team spearheaded by __________________________ arrived on _______________, 20__ to conduct a thorough examination of the money and sales accountability of, respondent as driver and collector from January 20__ to September 20__. A Photocopy of the said Audit Report dated ___________________, 20__ is hereto attached as Annex C. Based on the Audit Report submitted by _______________, he highlighted in his findings the following to wit: A) Upon further checking by the undersigned ___________________ of _________previous trip tickets, majority have discrepancies or differences on returned full/backload compared with sales supported by sales invoices. Also noted on __________ trip tickets were the absence of total cylinder content sold, which should have been indicated below the said trip tickets. B) That upon checking backwards of _____________sales and trip tickets, A TOTAL OF____________, AMOUNTING TO PHP _________ FROM JANUARY 20__, TO SEPTEMBER 20__ WAS MISSING IN THE SALES .WHILE JANUARY TO DECEMBER 20__,TOTALLED TO ______________AMOUNTING TO LOSSES OF PHP ______________. 4. That on __________ 20__, I requested respondent to explain in writing the discrepancies in his trip and cash sales. Respondent readily admitted to me his wrongdoing and in fact offered his motorcycle as partial payment while the rest will be paid in installment. Photocopy of the Written Explanation of respondent dated ________ 20__ is hereto attached as Annex D. 5. Truth to tell, respondent even turned over the original receipt and certificate of registration of his motorcycle.

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_______________even promised me that the next day he would furnish me a copy of the Deed of Absolute Sale of his motorcycle. 6. That sensing that ____________ would conduct a thorough investigation of the abovementioned financial irregularity, respondent did not report for work prompting ____________ to send two notices to report for work. In addition, I requested our company lawyer to send a demand letter to respondent. Photocopies of the Report to Work Notice dated ________________ and _______________ and the Demand letter dated ________________ are hereto attached as Annex E, F and G. 7. Obviously, respondent fearing the filing of criminal case chose not to report for work without any leave of absence. FLIGHT IS INDICATIVE OF GUILT. In spite of the diligent efforts exerted by _________, it could no longer locate respondent. 8. In spite of the receipt of said notices which was sent in the given address of the respondent based on their 201 files, respondent failed and refuse to report for work to the damage and prejudice of __________. 9. That respondents acts of falsifying trip reports to conceal the actual number of products sold by respondent and misappropriating the undeclared cash sales in the amount of ___________________________ submitted to __________________ in its principal office in ____________ City _______ and by refusing and failing to pay the same to ____________ has not only deprived __________of the use and enjoyment of said amount to its damage and prejudice. AFFIANTS FURTHER SAY NONE.

______________________ Affiant SUBSCRIBED AND SWORN to before me this ______ day of December 20__ at ______________ City.

___________________________ Assistant City Prosecutor CERTIFICATION I HEREBY CERTIFY that I have personally examined the affiantcomplainant and that I am satisfied that he voluntarily executed and understood his Complaint-Affidavit.

___________________________ Assistant City Prosecutor