Republic of the Philippines)

Kidapawan City )S.S.

x------------------------------------/

AFFIDAVIT OF DESISTANCE

I, _________________of legal age, Filipino, married and resident of

___________________, Philippines, hereby DECLARE AND MANIFEST:

That for and in consideration of the settlement made by _____________, I

hereby absolutely release, completely clear, and forever discharge _____________
from any action, cause of action, sum of money, liability, damages, claims and
demands whatsoever, which in law or in equity I have, or which I, my heirs,
insurer, successors and assigns hereafter may have upon or by reason of an
altercation which occurred last ___, around 8:45 o’clock in the evening in ____.

I execute this foregoing Affidavit with the intention to completely and

absolutely waive all my right of action, causes of action, claims and demands, of
whatever nature, arising from, or in connection with the aforementioned incident.

I further warrant that I will institute no further action against ____ arising
from, by reason of, or in connection with, the aforementioned incident.

I also manifest that the settlement made by ____ shall not be taken by me,
my heirs, my insurer or assigns, as a confession and/or admission of liability on the
part of ___ in connection with the aforementioned incident.

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of July,
2019 in Kidapawan City, Philippines.

_________
Affiant

SIGNED IN THE PRESENCE OF:

________________ _______________

SUBSCRIBED AND SWORN to before me this 7th day of July, 2019 in

Kidapawan City, Philippines.

Doc. No.____;
Page No.___;
Book No. II;
Series of 2019.

Page 1 of 1