REPUBLIC OF THE PHILIPPINES }

QUEZON CITY } S.S.

AFFIDAVIT OF DESISTANCE

I, 21 years old, Filipino, male, single, a resident, M M , a f t e r h a v i n g b e e n

s w o r n t o i n accordance with the law, do hereby depose and state that::

1. That I am the same with Drivers License No., involved in a

v e h i c u l a r accident on or about 7:05 PM of 2018 at along EDSA near corner Mariano Street.
`involving my Yamaha with No Plate and that of a Honda with plate No owned by of North
Balintawak, Quezon City.

2. That I have already entered an amicable settlement hence, I am no longer

interested in filing a case, either civil or criminal, nor testify against him in any court
or administrative agency, arising from the said vehicular incident.

3. That I am executing this affidavit in order to attest to the truthfulness of the

foregoing statements.

IN WITNESS WHEREOF, I hereunto set my hand this March __ , 2019 in the City of
Quezon, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this March ____, 2019 in the City of Quezon,
Philippines. I certify that I have personally examined the affiant and I am satisfied that
he has understood the contents of the foregoing affidavit of desistance and that he freely and
voluntarily executed the same.