Complaint Affidavit for Filing of BP 22 Case COMPLAINT-AFFIDAVIT
I, _____________, Filipino, of legal leg al age, (single / married / widow), and a resident of _____________, Philippines, after being sworn to in accordance with law, depose and state: That I know the person of __Respondent__, who is a resident of _____________, Philippines That sometime in the morning of __date of iss!e__, at __place of iss!e__, Philippines, the said __Respondent__ iss!ed in m" fa#or a __$ame of %ank__ &heck $o' ____________ _ in the amo!nt of P_____________ as s!pposed pa"ment for the loan accommodation of P_____________, which I ha#e etended to (him/her) That the said check is drawn against the acco!nt of the said __Respondent__ at __$ame of %ank__ with cco!nt $o' _____________ That at the time the said __Respondent__ iss!ed the deli#ered the said check to me, (he/she) made the ass!rance and representation that the said check is a good check and wo!ld be co#ered b" s!fficient f!nds when presented for pa"ment *owe#er, when the abo#e+mentioned check was depo sited, the same was dishonored and ret!rned b" the bank on the gro!nd that the same was drawn d rawn against a &-.01 &&.2$T3' tr!e and faithf!l machine reprod!ction of the said check is hereto attached as nne ____3 s s!ch, I immediatel" notified said __Respondent__ of the dishonor and ret!rn of the said check and demanded from (him/her) that (he/she) make good the said check within _____________ (____) da"s from receipt thereof' tr!e and faithf!l machine reprod!ction of m" demand letter to (him/her) is hereto attached as nne ____3 4hen said __Respondent__ failed to heed m" demands, I endorsed the said check to m" legal co!nsel who immediatel" sent a formal demand letter le tter thro!gh registered mail with ret!rn card on _____________, which was recei#ed b" the said __Respondent__ on __ ___________'s of date howe#er, __Respondent__ has !n5!stifiabl" ignored all these demands to p a" the said acco!nt and/or to redeem the said ret!rned check' tr!e and faithf!l machine reprod!ction of m" demand letter to (him/her) is hereto attached as nne ____3 I am therefore eec!ting eec! ting this &omplaint+ffida#it in s!pport of the charges for 6iolation 6iolation of %atas Pambansa %ilang 77 against the said __Respondent__, who ma" be ser#ed with s!bpoena and other processes of this *onorable .ffice at (his/her) last known address at ____________ _, Philippines
I$ 4IT$0 4*0R0.F, I ha#e here!nto set m" hand this _____________ at _____________, Philippines' COMPLAINANT
2%&RI%01 $1 4.R$ to before me this _____________ at _____________'I hereb" certif" that I ha#e eamined the ffiant and that I am f!ll" satisfied that (he/she) has #ol!ntaril" eec!ted and !nderstood the contents of (his/her) &omplaint+ffida#it' dministering .fficer
Complaint Affidavit BP 22 Rep!blic of the Philippines ) ____________________________ +++++++++++++++++++++++++++++++++++
) ' '
COMPLAINT AFFIDAVIT I, ________________________________ , Filipino, of legal age, with postal address at
_____________________________________________ , after being d!l" sworn in to accordance with law, hereb" depose and sa": 8'
That I am filing a complaint against for
0stafa and for #iolation of %P 77, who can be ser#ed with s!mmons and notices at _________________________________________________________________' 7'
That sometime on _________________________ at m" residence in the &it" of
9anila, con#inced
me to take her check
for
redisco!nting
representing that the checks will be good on the date indicated on the checks' '
That the respondent deli#ered se#eral checks and T4. (7) among se#eral checks are
the s!b5ect of this case amo!nting to P7;,<<<'<<, to wit:
_____________________ %$= (nne )
<
9a" 7<, 7<88 P;>,?;<'<<
_____________________ %$= (nne %)
<
@!ne 7<, 7<88 P;>,?;<'<<
____________________
T.T-:
P!!"#$%%&%%
A'
That on the dates of the check I deposited the same and to m" disma" the" all came
back with annotations &&.2$T &-.01' ;'
That she defra!ded me to part with m" mone" when he iss!ed a check with
ins!fficient f!nds and worse acco!nt closed' he iss!es checks knowing #er" well that the same is worthless' B'
That !pon bo!ncing of the checks I P0R.$--C deli#ered a demand letter to the
respondent gi#ing her a chance to make good the pa"ments of the checks b!t she chose to ignore the same' ?'
*erein attached is the 1emand -etter deli#ered personall" to the respondent on
____________, 7<88 as ANN'( )C*& IN WITNESS WHEREOF , I ha#e affied m" signat!re this ___ da" of ____________ 7<88 in
_________________, Philippines'
_________________________________ Complainant SUBSCRIBED AND SWORN to before me this ______ day of ___________,2011 in __________. I further certify that I have personally examined the Affiant and I am satisfied that she voluntarily executed her Counter-Affidavit and that she understood the contents of the same.
ADMINISTERING OFFICER
