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Affidavit of Disinterestedness

This affidavit details a domestic violence incident between the affiant and her former partner. She reports that he punched her in the face on May 31, 2018. However, they have since reconciled and she no longer wishes to pursue criminal charges. She acknowledges settling the issue beforehand and accepts his apology. The affiant declares a lack of interest in filing any related suits and requests the police disregard the incident report. She affirms executing the affidavit voluntarily without coercion.

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Jaelein Nicey A. Monteclaro
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169 views1 page

Affidavit of Disinterestedness

This affidavit details a domestic violence incident between the affiant and her former partner. She reports that he punched her in the face on May 31, 2018. However, they have since reconciled and she no longer wishes to pursue criminal charges. She acknowledges settling the issue beforehand and accepts his apology. The affiant declares a lack of interest in filing any related suits and requests the police disregard the incident report. She affirms executing the affidavit voluntarily without coercion.

Uploaded by

Jaelein Nicey A. Monteclaro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines )

Province of Agusan del Sur ) S.c.


Municipality of Prosperidad )
x - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -/

AFFIDAVIT OF DISINTERESTEDNESS

I, _______________, Filipino, of legal age, single, and a bonafide resident of


__________________________________________________, after having been duly sworn in accordance
with law, hereby depose and say THAT:

1. That I am the victim as well as the former live-in partner of the suspect,
____________________________ who is currently residing in Tandag City, Surigao del Sur,
Philippines;

2. That I reported my him to the police officers of ___________ Municipal Police Station
for hitting me and punching my face at around eleven o’ clock in the evening of
May 31, 2018 at our residential abode situated at
____________________________________________;

3. That for humanitarian considerations, we have already settled the issue and
reconciled beforehand. He beseeched for my forgiveness and accordingly I have
accepted the same considering that he is remorseful of what he did;

4. In view of the foregoing, I hereby confess, declare and manifest my LACK OF


INTEREST and desistance for the time being from filing any suit, whether
criminal, civil or administrative, arising out of this incident, without prejudice to
filing of subsequent criminal charges on valid grounds as provided by law;

5. That we consider this case closed and request the handling police officer to
disregard the blotter for reason afore-stated;

6. The foregoing statements have been fully read and translated to me in Visayan
dialect, which I understand and that I fully understood their meaning and
importance;

7. That I am executing this affidavit voluntarily and free from any form of coercion,
compulsion and undue influence and was duly informed of the consequences of its
execution.

IN WITNESS WHEREOF, I have hereunto affixed our hands this 1st day of March
2022 at the ___________________________.

_________________________
Affiant
________________________

SUBSCRIBED AND SWORN to before me 1st day of March 2022 at Prosperidad, Agusan
del Sur, Philippines. Affiants exhibited to me the above-mentioned cards as competent
proof of their identities.

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