Republic of the Philippines)

City of Cebu.......................)S.S.

AFFIDAVIT OF DESISTANCE

I, ________________, Filipino, of legal age, and a resident of Brgy. Ibabao,

Sogo, Cebu, Philippines, after being sworn to in accordance with law, hereby
depose and state:

1. That I am the opposite party of the vehicular accident that took place on
March __, 2017 at around 8______________ in Sogod, Cebu;

2. That I was driving a motorcycle at that time with Plate No. __________ while
the other party was driving a gray Toyota Avanza vehicle with Plate No.
______________ driven by Mr. _______________;

3. That at the time of the incident, I was alone and was carrying a Students
Permit with No. _______________ while Mr. _____________________ was
carrying his Drivers License with No. __________________ with an expiry date
of ______________;

4. That I was driving ahead/in front of a six-wheeler truck while Mr.

_____________________ was driving behind the six-wheeler truck. When I was
hand signaling to turn to the left, Mr. _____________________ was also in the
process of overtaking the six-wheeler truck.

5. Considering that the incident is purely accidental in nature and that neither
party intended this to happen, Mr. _____________________ and I, through our
own volition, agreed to compromise and settle this case out of court;

6. It is for this reason that my family and I will not anymore pursue any legal
action arising out of this incident against Mr. Dennis _____________________
or any of his employers;

7. 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;

8. The foregoing statements have been fully read to me and I fully understood
their meaning and importance;

9. 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 hand this ________________ at

Cebu City, Philippines.

_____________________________
Affiant
Drivers License ID No. _______________

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 SUBSCRIBED AND SWORN TO before me this _________________ in Cebu
City, Philippines, affiant exhibited to me his proof of identity, the pertinent
details of which appear below his name.

Doc. No. _____;

Page No. ____;
Book No. ____;
Series of 2017.

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