REPUBLIC OF THE PHILIPPINES)

CITY OF ____________________) S.S.

x------------------------ x

AFFIDAVIT OF DESISTANCE

I, _____________________, Filipino, of legal age, and with residence

at ________________________________, after being duly sworn to in
accordance with law hereby depose and state that:

1. I am the private complainant in the case which I filed against

______________________________ for non-payment of Social
Security System (SSS) premium/contribution;

2. After re-evaluating the case and its attending circumstances,

_______________________ has already complied with its obligation
under the SSS Law, thus, I am no longer interested in pursuing my
complaint against _________________________and that I hereby
voluntary and freely withdraw them by executing this Affidavit of
Desistance;

3. I am fully aware that with this Affidavit of Desistance, I could no longer

re-file these complaints and that the same are forever barred;

4. I also declare that by virtue of this Affidavit of Desistance, I absolutely

and irrevocably waive, release and discharge
____________________from any action or actions, cause or causes
of actions, sum of money, accounts, damages claims and demands
whatsoever, in law or equity that I can or may have upon and by any
reason whatsoever in connection with or related to and such other
claims and demands as set forth in the above-entitled cases pending
before this Honorable Office;

5. Hence, I respectfully ask this Honorable Office to dismiss this

complaint by virtue of this Affidavit of Desistance;
 AFFIDAVIT OF DESISTANCE
Page 2 of 2

6. I further attest that, this Affidavit of Desistance is executed voluntarily,

without force or intimidation or promise of reward whatsoever.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of

_______ 2014 in the City of ____________.

________________
Complainant/Affiant

SUBSCRIBED AND SWORN TO before me this ___ day of

____________, 2014 at the City of _______________. Affiant exhibited to
me his __________________ as competent proof of identity.

Doc No.____;
Page No.___;
Book No.___;
Series of 2014.