Republic of the Philippines}

C I T Y O F xxxxxxxxxxx }s.s.

COMPLAINT AFFIDAVIT

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

xxxxxxxxxxxxxxxxxxxxxxx, Philippines, after having been sworn to in Commented [B1]: Verify kung kani lang gihapon ang
iyahang address
accordance with law, do hereby depose and say THAT:

1. xxxxxxxxxxxxxxxxxxx is my legal husband and we have two

(2) children, namely:
a. xxxxxxxxxxxxx, born on March 15, 2000; and
b. xxxxxxxxxxxxxxx, born on September 20, 2002.
A copy of our marriage contract is hereto attached as ANNEX
“A”;

2. xxxxxxxxxxxxxxxxxxxxx, is a government employee who

works as a xxxxxxxxxxxxxxxx ; Commented [B2]: Hmm, not sure, pero basi pwede
butangan ug annex e.g. payslip niya to show na
government employee jud siya. :D
3. I am instituting this complaint against xxxxxxxxxxxxxxxx, for
xxxxxxxxxxxxxxxxxx as defined and penalized under Article
172 paragraph 1 in relation to Article 171 paragraph 2 of the
Revised Penal code;

4. On three different dates, my husband xxxxxxxxxxxxxxxxxx

secured three different loans from xxxxxxxxxxxxxxxxx and
placed on the respective loan applications and the promissory
notes, signatures which purport to be my signature and caused
it to appear that I participated in securing the said loans and
gave my marital consent to it, when in truth and in fact I had no
knowledge and had not consented to the obtaining of the same.

5. The acts complained of are more specifically described as

follows:

a. On April 19, 2007, xxxxxxxxxxxxxxxxxx secured a loan of

Php 29,000.00 from xxxxxxxxxxxxxxxxx bank and placed
on the loan application and the promissory note, signatures
which purport to be my signature, thereby making it appear
that I consented to the securing of the loan. A copy of the
loan application and promissory note bearing the forged
signatures are hereto attached as ANNEX “B” and
ANNEX “B-1” respectively;

b. On April 28, 2008, he secured a second loan in the amount

of Php 29,000.00 from xxxxxxxxxxxxxxxxxxx Bank, and
again placed on the loan application and promissory note,
signatures which purport to be my signature, thereby
making it appear that I participated in the securing of the
aforestated loan. Attached hereto are copies of the loan
 application and the promissory note bearing the forged
signatures as ANNEX “C” and “C-1” respectively; Commented [B3]: Ask for a copy of these para ma
attach – kay ang first lang ang naa kopya. Saying
para ma 3 counts
c. On April 22, 2009, he secured a third loan in the amount of
Php 29,000.00 from xxxxxxxxxxxxxxxxxxxxxx and again
placed on the loan application and promissory note,
signatures purporting to be my own, so as to make it
appear that I participated and gave my marital consent in
obtaining the said loan. Attached hereto are copies of the
loan application and promissory note bearing the forged
signatures marked as ANNEX “D” and ANNEX “D-1” Commented [B4]: Ask for a copy of these too and
attach
respectively;

6. I only came to know of the existence of the aforestated loans

when I inadvertently discovered the same when I asked for his
pay slip from the City Hall;

7. A copy of my identification card bearing my true signature and a

copy bearing my specimen signatures are hereto attached as
ANNEX “E” and ANNEX “F” respectively, to show that the
signatures appearing on the loan applications and the
promissory notes herein attached as ANNEXES “B”, “B-1”,
Commented [B5]: Ipaphotocopy ang iyahang id
bearing photo and true signature para mas naa weight
and on a separate paper, mag butang siya ug at least
3 specimen signature.

“C”, “C-1”, “D” and “D-1” are all forgeries.

8. That I am executing this affidavit to attest to the truth of the

foregoing averments and for the purpose of criminally
prosecuting xxxxxxxxxxxxxxxxxxxx for three counts of
xxxxxxxxxxxxxxxxxxx who could be served with summons at
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx. Commented [B6]: Verify if mao gihapon ni ang
address

IN WITNESS WHEREOF, I have hereunto affixed my signature this

___ day of _______, xxxx at xxxxxxxxxxxxxxxx City, Philippines.

________________________
xxxxxxxxxxxxxxxxxxxxxxxxxx
Affiant

SUBSCRIBED AND SWORN to before me this ______________ at

Davao City, Philippines. I CERTIFY that I have personally examined the
affiant and I am satisfied that she voluntarily executed the foregoing
affidavit complaint and read and understood the contents of the same.