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PROVINCE OF ______________
CITY OF ______________

) S.S

I, ___________________, am of legal, Filipino citizen, and a resident
of ______________________________, after having been duly sworn to in
accordance with law, hereby depose and state that:
1. I
________________________________ docketed as NPS Doc.
No. II-02-INV-15F-00194 which is presently lodged before
2. Finally, the respondent and I have peacefully and
successfully settled the matter relative to this case. And
that what we wanted now is to save and restore the good
and amicable relationship that we have with one another
specially so that I value so much my relationship with my
sister, the wife of herein respondent;
3. As a sign of goodwill, I finally manifest that I am now
completely and absolutely withdrawing from further
prosecuting the respondent in the instant case;
4. For these reasons, I am now manifesting my lack of interest
in further proceeding of the case against the respondent;
5. In view of this development, I am now respectfully praying
before this Honorable Office to dismiss the instant case and
to consider the same as closed and terminated;
6. I was not forced, coerced, intimidated or threatened by the
respondent in executing this affidavit of desistance but only
for the foregoing reasons;
7. There is no monetary reward involved for my desistance
against the herein respondent;

8. Further, I will no longer file any case relative to my

complaint against the respondent before any judicial
agency/court in the Philippines;
9. I am fully aware of the legal imports of executing this
affidavit and that the statements hereof are explained to me
and to my father;
10. I am freely and voluntarily executing this affidavit to
attest to the truthfulness and veracity of the foregoing facts
and for whatever legal intents and purposes it may serve.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this
___________________, at __________________________.

ID No. ____________________
Issued by _________________________
Valid until _________________________
SUBSCRIBED AND SWORN to before me this ________________ at
Tuguegarao City, Cagayan. Affiant exhibited his/her Identification card
written and indicated below his/her name and signature, as a
competent proof of his/her identity.

Doc. No. :______;

Page No. :______;
Book No. :______;
Series of 2016.