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Republic of the Philippines OFFICE OF THE CITY PROSECUTOR City of ______________

______________________, Complainant, - versus ______________________, Respon!ent. "-----------------------------------" I.S. No. For: ttempte! Rape

I, _____________________, of le#al a#e, Filipino, sin#le, an! $ith postal a!!ress at No. ________________________________, after havin# s$orn to in accor!ance $ith la$, hereby !epose an! state that: %. I am filin# a complaint a#ainst ______________ for Attempted Rape, $ho can be serve! $ith summons an! notices at ________________________________& '. (he inci!ent happene! $hen I $as still __________ years ol!. I $as then livin# $ith my father, the above-name! accuse!, at ________________________________, as my mother $as then $or)in# abroa!& *. Sometime in the evenin# of ____________________, I $as sleepin# in my room at our resi!ence at ______________________. Su!!enly, I $as a$a)ene! $hen I felt someone lay on top of me an! somethin# har! $as thrust in my private or#an& +. (o my surprise, I sa$ my father, herein accuse! ______________, on top of me. ,e $as starin# at me $hile touchin# my breast. t the same time, I sa$ his penis touche! my private or#an. I felt pain because of his attempt to insert his penis into my va#ina. t that time, my un!er$ear -panty. $as lo$ere! to my )nees& /. I trie! to push him a$ay but he $as too heavy. I be#an to cry an! be##e! him to stop. ,e su!!enly stoppe!, stoo! up an! hurrie!ly pulle! up his un!er$ear. 0. Fear of my father1s authority an! shame )ept me from revealin# to others my #hastly or!eal at the han!s of my very o$n father. 2oreover, I also feare! the accuse!1s threat to my life an! on the

lives of my mother an! siblin#s. 3. (rue enou#h, $hen my mother came bac) from abroa! an! staye! here for #oo! that she $as emotionally an! physically abuse! by my father, the herein accuse!, $hich le! to their separation. 2y mother left our house an! brou#ht us to her parents1 house in __________________ leavin# my father in _____________& 4. It $as only on __________________ that I can no lon#er bear the horrible e"perience I ha! at the han!s of my o$n father. I tol! my mother everythin# that my father !i! to me $hen she $as still abroa!& 5. I am e"ecutin# this affi!avit to attest to the truth of the fore#oin# facts an! for the purpose of filin# a criminal complaint a#ainst herein accuse! __________________ for the crime of ATTEMPTED RAPE. IN WITNESS WHEREOF, I am affi"in# my si#nature this ____ !ay of _________________, '6%* at ___________________.

_________________________ Complainant SUBSCRIBED AND SWORN to before me this ___ !ay of ____________, '6%* at ___________________.