Republic of the Philippines }

City of San Fernando, Pampanga } S.S.

AFFIDAVIT OF DESISTANCE
I, ________________________, Filipino, of legal age. and with postal address
at _____________________________, after being sworn according to law, depose and
say that:

1. I am the Private Complainant in the case entitled,

“___________________________, Criminal Case No. _________, For
_____________________________________, which case is now pending before
the MTCC Branch ________ - San Fernando, Pampanga;

2. After mulling over the incident that led to the filing of this case, the parties have
mutually agreed to settle the case amicably.

3. Because of these recent developments, I am no longer interested in and will desist

from prosecuting the criminal case for Estafa against
___________________________________), and will instead request that the City
Prosecutor assigned to the case to move for the withdrawal of any Information or
complaint filed and/or the dropping of Criminal Case No. ____________.

4. I fully understand that, when this case is dismissed, I will no longer be able to
revive the case against him for the same subject matter.

5. I knowingly make this sworn statement of my own free will and volition, and I
further state under oath that I was not coerced to do so, nor under duress at the
time of executing this affidavit of desistance.

6. I am executing this affidavit to attest to the truth of the foregoing, and for the
purpose of causing the dismissal of Criminal Case No. __________ against
__________________________________.

IN WITNESS WHEREOF, we have hereunto set my hand this _______ day of

September, 2018 in the City of San Fernando, Pampanga.

______________________________
Affiant

Republic of the Philippines }.

City of San Fernando, Pampanga } S.S.

SUBSCRIBED AND SWORN, to before me this ______ day of ____________,

2018 in the City of San Fernando, Pampanga, Philippines, affiant exhibiting to me his
____________________________ issued at ___________________ with expiry date
_______________.

WITNESS MY HAND AND NOTARIAL SEAL on the date and at the place first
above-written.

Notary Public

Doc. No. ______

Page No. ______
Book No. ______
Series of 2018.