REPUBLIC OF THE PHILIPPINES
)
__________________________________
) S. S.
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AFFIDAVIT OF DESISTANCE
I, Andrea Diane Iposada y Tongohan, of legal age, Filipino, married, and a resident of 60
E. Rodriguez Avenue barangay Katipunan Bayani, Tanay, Rizal, Philippines, after being sworn
to according to law, depose and say, that:
1. That I am a victim of THEFT that happened on February 25, 2022, at 1:25 pm, while having
lunch together with my friends in Daily Beans Coffee Lounge and Restaurant, Pililla, Rizal
Philippines,
2. That I believe that the incident was a case of misunderstanding;
3. In view of the foregoing, I hereby confess, declare, and manifest my ABSOLUTE LACK
OF INTEREST and PERMANENT DESISTANCE from filing any suit, whether criminal,
civil, or administrative, arising out of this incident;
4. I have already settled the matter amicably and my family and I will not anymore pursue
any legal action against ESTONEGIE DIONALDO y Oyos
5. The foregoing statements have been fully read and translated to me in Tagalog dialect,
which I understand and that I fully understood their meaning and importance;
6. I execute this affidavit to attest to the truth of the foregoing statements and for whatever
legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hands this ______________,
______________________________, Philippines.
Andrea Diane Iposada y Tongohan
Affiant
ID Type: ______________
ID No. ________________
Issued on ______________
Issued by ______________
SUBSCRIBED AND SWORN to before me this ___________________, in the
__________________________, Philippines. I further certify that I have personally examined the
herein affiant and I am convinced that he/she executed the same freely and voluntarily and
understood its contents.
Doc. No. _________;
Page No. _________;
Book No. _________;
Series of ____.