Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE OF THE PROVINCIAL PROSECUTOR
Province Of___
_____________City
PEOPLE OF THE PHILIPPINES
Complainant
-versus-
_________________________
Respondent
COUNTER AFFIDAVIT
I __________________________ Filipino of legal age, single and presently residing at
________________________, after having been sworn in accordance with law do hereby depose and say:
1. That I am the same person who is charged with the crime of ______________pending before the
office of the Prosecutor of ___________, docketed under_______________;
2. That Paragraph ___ of the Sworn Statement of ____is denied. The truth of the matter as are
follows:____________________
3. That ____________________________________
4. That __________________________________
5. That __________________________________
6. That I am voluntarily executing this affidavit to attest to the truthfulness of the foregoing facts
and to support the outright dismissal of the complaint filed against me.
IN WITNESS WHEREOF, I have hereunto affixed my signature on this __th day of _____, 20__
at_____________.
________________________________
Affiant
SUBSCRIBE AND SWORN to before me this ___th day of _________________, 20__ at________
I hereby CERTIFY that I have personally examined the Affiant and that I am satisfied that he has
voluntarily executed and understood his Counter-Affidavit.
___________________________________
Asst. Prov. Prosecutor