Republic of the Philippines)
____________, ________ ) s.s.
x- - - - - - - - - - - - - - - - - - - - - -x
COMPLAINT AFFIDAVIT
The UNDERSIGNED, __________________________, accuses _________, of
_____________, committed as follows, to wit: That on or about _________, at about
_____________ in the _________________, ______________, Philippines, the said
accused did then and there willfully, unlawfully, feloniously, and by means of
_____________, committed _____________, upon the undersigned directly by overt
acts to wit: (state the details how the crime was committed).
The undersigned executed this affidavit to attest the truthfulness of the foregoing facts
and to support the filing of Criminal Cases
against _______________________________ for violations of
________________________.
___________, this _____ day of __________, ____.
____________________________
Offended Party
SUBSCRIBED AND SWORN to before me this ___ day of _______ at
_______________. I HEREBY CERTIFY that I have personally examined the herein
offended party and I am satisfied that they voluntarily executed and understood their
given affidavit.