Republic of the Philippines]

CITY OF BATANGAS] ss

AFFIDAVIT OF DESISTANCE

I, ___________________________of legal age, single and a resident of

___________________ Batangas City, Batangas, after having been sworn to in
accordance with the law, do hereby depose and state that:
1. That I am the same_____________________, involved in a vehicular
accident on ___________________involving my Toyota Camry with Plate No.
______________________

and

that

_____________________

and

driven

of

a
by

vehicle

owned

by

________________of

_______________.

2. That I have already entered an amicable settlement with_________-, hence, I

am no longer interested in filing a case, either civil or criminal, against
_______________ or __________nor testify against them in any court or
administrative agency, arising from the said vehicular accident.
3.

That I am executing this affidavit in order to attest to the truthfulness of the

foregoing statements.

IN WITNESS WHEREOF, I hereunto set my hand this__________, 2016 in the City of

Batangas, Philippines.

_____________________________
Affiant