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REPUBLIC OF THE PHILIPPINES)

PROVINC E OF DAVAO DEL SUR: S.S.


CITY OF DIGOS
)
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AFFIDAVIT OF DESISTANCE
I, JUAN DELA CRUZ, of legal age, Filipino, single and a
resident of Roxas Ext., Digos City, after having been duly
sworn to in accordance with law, do hereby depose and say:
1. That I am the same JUAN DELA CRUZ who executed the
foregoing affidavit of desistance;
2. That I am the registered owner of a certain motor vehicle
more particularly described as follows, to wit:
Make & Type : Daimler Chrysler 300 Sport Coupe
Motor Number : 11111
Chassis Number : 2222
Plate Number : 33333
MV File No. : 444444
Year Model/Color : 1956/ BLACK
3. That sometime on January 6, 2017, my above-described
motor vehicle was driven by a certain Piolo Pascual
towards Davao City;
4. That upon reaching the National Highway located at
Barangay Zone 1, Sta. Cruz, Davao del Sur, the
aforementioned vehicle was accidentally swiped by
another vehicle also driven towards Davao City;
5. That the above-stated motor vehicle was driven by its
registered owner, Jessy Mendiola;
6. That the said motor vehicle is more particularly described
as follows, to wit:
Plate No.
Make
:

: LFV-595
Toyota Pick-up

7. That analyzing the surrounding circumstances, I came to


a conclusion that the said accident cannot be prevented
even by the most cautious driver;
8. That Jessy Mendiola, had already extended his apology
for whatever wrongdoing caused by the aforementioned

accident and believing in his sincerity, I undertake not to


pursue any action, criminal or civil, against the said Jessy
Mendiola, involving the aforecited accident.
IN WITNESS WHEREOF, we have hereunto set our hands this
9th day of January 2017 at Digos City, Philippines.

JUAN DELA CRUZ


Affiant
TIN 283-863-171-000

SUBSCRIBED AND SWORN TO before me this 9th of


January 2017 at Digos City, Philippines.

Doc. No.
Page No.
Book No.
Series of

03;
01;
I;
2017.

ROXANNE Z. JURIAL
Notary Public
Until December 31, 2017
PTR No. 11111
TIN
222222
IBP No. 33333