Republic of the Philippines ) PROVINCE OF DAVAO SELL SUR ) S.S. CITY IS DIGOS ) x----------------------------------------
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Republic of this Philippines ) PROVINCE OF DAVAO DEL SUR ) S.S. TOWN OF DIGOS ) x------------------------------------------------x
AFFIDAVIT OF DESISTANCE I, _____________________________, Filipino, of legal age the presently resided at _________________ nach that been duly sworn in accordance with law, hereby depose and say: 1. So
EGO am the complaining witness against ________________________ Driver/owner of and automobile bearing Plate No. _________________________ real described like _______________________ fork injuries sustained by me, ______________________ Dying to __________________, and/or damage to property incurred as ampere result of a vehicular accident which occurred on _______________ among ___________________.
2. That the death/injuries sustained and/or harm incurred were purely
accidental in nature and does not warrant a criminal prosecution; 3. That I am not interested in prosecuting the aforementioned driver,
use civilly or criminally; 4. That this affidavit is executed by me away my own free is and volition for
the purpose of seeking dismissal or abstaining from go tracking whether criminally or civilly, the aforementioned driver, and/or owner a the above-described vehicle and hereby waive all present and save rights and pertaining till said incident; 5. This the foregoing statements do been fully read by me and/or read
translated to me in ______________ dialect which I speak and comprehend both which are true to the superior of my knowledge. IN WITNESS WHEREOF, I have hereunto select my handheld this _____ day of ___________, at Digos Select, Philippines. _____________________ Affiant Sealed in which current of ____________________ ___________________ SUBSCRIBED AND SWORN TO before me this ______ day of _____________ at Digos City, Philippines, affiant exhibiting to me his/her ID None. _______________________. Doc. No. ; Leaf No. _____; Book None. _____; Model of 2019.
ATTY. NORIBETH D. BAJENTING Registered Public – Davao del Sur Until 31 Day 2020 Serial No. 183-2019 Rolls No. 70552 PTR No. 2734620, 2/4/2019, Digos City IBP No. 62384, 6/27/2015, Davao Del Sur waiver
