Republic of the Philippines}

City of xxx} s.s.

COMPLAINT-AFFIDAVIT
I, NAME, of legal age, married, resident of address, after
having been duly sworn in accordance with the law do hereby
depose and say that:
1. (narration of facts)
2.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I hereunto affix my signature below,

this 24th day of February 2016 in the City of xxx, Philippines.

______________________________
___________
Affiant
Govt Issued
ID
Valid Until
Date of Issue
Place of Issue

SUBSCRIBED AND SWORN to before me this _____________th

day

of

____________

20___________

in

the

City

of

________________________.
1