REPUBLIC OF THE PHILIPPINES )
--------------------- ) S. S.
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AFFIDAVIT OF NO INTEREST TO FILE CRIMINAL CHARGES
I, XXX of legal age, Filipino, married and a resident of Barangay Buyun Sta. Teresita,
Cagayan, Philippines, after being sworn to according to law, depose and say, that:
1. That I am the walk in complainant who sought police assistance before Cagayan Police
Provincial Office, Sta. Teresita, Cagayan at about 3:30 in the afternoon of August 20, 2020
because I was defrauded by respondents identified as AAA, 27, years old, single and a
resident of Cataggaman, Tuguegarao City and BBB, 24 years old, married and a resident
of Barangay Buntun, Tuguegarao City, both sales agents and employees of Y Company;
2. I and herein respondents have reached an amicable settlement to avoid future litigation
in relation to the above incident;
3. In view of the foregoing, I will not anymore pursue any legal action against the
respondents and I hereby confess, declare and manifest my ABSOLUTE LACK OF
INTEREST and PERMANENT DESISTANCE from filing any suit, whether criminal,
civil or administrative, arising out of this incident;
4. The foregoing statements have been fully read and translated to me in a dialect known
to me, which I understand and that I fully understood their meaning and importance;
5. I execute this affidavit to attest to the truth of the foregoing statements and for whatever
legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hands this _______ day of August,
__________ at Tuguegarao City, Philippines.
XXXXXXXXXXXXXXXXXXXXXX
Affiant
ID Type: ______________
ID No. ________________
Issued on ______________
Issued by ______________
SUBSCRIBED AND SWORN to before me this __________ day of August, ________ at
Tuguegarao City, Philippines. I further certify that I have personally examined the herein
affiant and I am convinced that she executed the same freely and voluntarily and understood its
contents.
Doc. No. _________;
Page No. _________;
Book No. _________;
Series of 2020.