Republic of the Philippines)
City of Davao )s.s.
x---------------------------------------x
AFFIDAVIT-COMPLAINT
I, ________________________________, of legal age, Filipino, and a resident of
Davao City, Philippines, after having been duly sworn to in accordance with law, do
hereby depose and state that:
1) I am instituting this Criminal Complaint against _____________________,
of legal age, Filipino and a resident of __________________________, Philippines, for
having committed the crime of QUALIFIED THEFT, as defined and penalized under
Article 310 of the Revised Penal Code, as amended by Batas Pambansa Bilang 71;
2) The acts complained of were committed as follows:
a)
b)
c)
3) Based on the foregoing acts of ___________________________, he clearly
committed the crime of QUALIFIED THEFT under Article 310 of the Revised Penal
Code, as amended by Batas Pambansa Bilang 71, when she abused the trust and
confidence reposed upon him by __________________________, and took personal
property from the latter amounting to a total of __________________________________
(Php __________________) for his personal gain and benefit;
IN WITNESS WHEREOF, we have hereunto set our hand this ________________
2016 in Davao City, Philippines.
____________________________________
Affiant
SUBSCRIBED AND SWORN to before me this ________________ 2016 in Davao
City, Philippines. I HEREBY CERTIFY that I have personally examined the Affiant and
that I am satisfied that he has read and understood the foregoing Affidavit and that the
same was voluntarily executed by him.
_________________________________
1|Page