Republic of the Philippines ) ____________, ________ ) s.s. x- - - - - - - - - - - - - - - - - - - - - -x AFFIDAVIT OF COMPLAINT The UNDERSIGNED, Desiree de la Cerna, accuses Mr.

Valdemor Refuerzo, Qualified Rape through intercourse, committed as follows, to wit: That on or about January 15, 2011, at about 0000H in the Residence of the accused, in Cainta, Rizal, Philippines, the said accused did then and there willfully, unlawfully, feloniously, and by means of force and intimidation, committed Qualified Rape, upon the undersigned directly by overt acts to wit: (state the details how the crime was committed). The undersigned executed this affidavit to attest the truthfulness of the foregoing facts and to support the filing of Criminal Cases against Mr. Valdemor Refuerzo, for violations of ________________________. ___________, this _____ day of __________, ____. ____________________________ Offended Party SUBSCRIBED AND SWORN to before me this ___ day of _______ at _______________. I HEREBY CERTIFY that I have personally examined the herein offended party and I am satisfied that they voluntarily executed and understood their given affidavit. _________________________ Judge WITNESSES: __________________________ __________________________

Republic of the Philippines ) ____________, ________ ) s.s. x- - - - - - - - - - - - - - - - - - - - - -x AFFIDAVIT OF WITNESS I, ________________________, age, civil status, resident of __________________________, _________, after having sworn in accordance with law, do hereby depose and state THAT: 1. I was present and personally saw that accused, __________, committed the crime of ___________________________ against the victim _______________; 2. both); 3. 04. (State the details of the acts committed by the accused against the victim. (State the acts done by the witness and the reason thereof); (State other circumstances and the relation either to the victim or accused or

I executed this affidavit to attest the truthfulness of the foregoing facts and to support the filing of Criminal Cases against _______________________________ for violations of ________________________. AFFIANTS SAYETH NAUGHT. IN WITNESS WHEREOF, I hereunto affixed my signature this ___day of ____________ at ____________, _______________. _______________________________ Affiant SUBSCRIBED AND SWORN to before me this ___ day of _______ at _______________. I HEREBY CERTIFY that I have personally examined the herein affiants and I am satisfied that they voluntarily executed and understood their given affidavit. _____________________ Notary Public

Sample of Affidavit of Arresting Officers

Republic of the Philippines )