The UNDERSIGNED, __________________________, accuses _________, of
_____________, committed as follows, to wit:
That on or about _________, at about _____________ in the _________________,
______________, Philippines, the said accused did then and there willfully, unlawfully, feloniously, and by means of _____________, committed _____________, upon the undersigned directly by overt acts to wit: (state the details how the crime was committed). The undersigned executed this affidavit to attest the truthfulness of the foregoing facts and to support the filing of Criminal Cases against _______________________________ for violations of ________________________.
___________, this _____ day of __________, ____.
____________________________ Offended Party
SUBSCRIBED AND SWORN to before me this ___ day of _______ at _______________. I
HEREBY CERTIFY that I have personally examined the herein offended party and I am satisfied that they voluntarily executed and understood their given affidavit.