Republic of the Philippines ]

City of D U M A G U E T E ]s.s.

AFFIDAVIT OF DESISTANCE

I, ________________, of legal age, Filipino, married and a resident

of _____________________ on oath depose and say that:

I am the private complainant in NPS Docket No._________________,

pending before the Office of the Provincial Prosecutor’s Office of Negros
Oriental against __________________;

This case arose out from misapprehension of facts and the respondent
has decided to settle the civil aspect of this case and for which reason, the
private complainant has lost her interest in pursuing these cases;

I am therefore, asking that the above-mentioned case against

____________________ will be dismissed;

Likewise, I will not be filing any case anymore against the respondent
that arises out of the same incident as with the case above-mentioned and
other related cases;

I am executing this affidavit voluntarily, freely and without any force

exerted against me and to prove the foregoing facts and circumstances.

IN WITNESS WHEREOF, I hereunto set my hand this ____day of

November at Dumaguete City, Philippines.

_____________
[Affiant]

SUBSCRIBED AND SWORN to before me this ____day of November

2011, at Dumaguete City, Philippines.

CERTIFICATION

I hereby certify that I have examined the affiant and I am convinced

that she executed the same freely and voluntarily and she understood all the
allegations therein.