Republic of the Philippines

Department of Justice
OFFICE OF THE PROSECUTOR
Rodriguez, Rizal

_______________________________
Complainant,

- versus - I.S. NO. ________________

For: SLIGHT PHYSICAL INJURY

Under Art. 266 of the
Revised Penal Code
______________________________
Respondent.
x---------------------------------------------------------x

COMPLAINT AFFIDAVIT

I, ______________________________, of legal age, Filipino citizens,

married, residing at ______________________________, after having duly sworn
to in accordance with law do hereby depose and say:

1. That I am the complainant in the above-entitled case;

2. That I am formally charging respondent

______________________________, with postal address at
______________________________ for the crime of Slight Physical
Injuries penalized under Art. 266 of the Revised Penal Code.

Article 266. Slight physical injuries and maltreatment. – The

crime of slight physical injuries shall be punished:

1. By arresto menor when the offender has inflicted physical

injuries which shall incapacitate the offended party for
labor from one to nine days, or shall require medical
attendance during the same period; … xxx

3. The essential facts and elements constituting the crime of Slight Physical
Injuries under Article 266 of the Revised Penal Code are committed as
follows:

a.) That on the morning of October 11, 2018 at around the time of more
or less 6:40 am, while I was standing in front of the store adjacent to
the house of ______________________________ located at
 ______________________________, with me is my 6 years old
daughter ______________________________, I saw the herein
respondent Bundalian approaching at our location with the intent to
hurt me and shouted “ Bakit mo ako tinititigan”, and maliciously
shouted and pointing fingers at my person, while my daughter and
other person around the store vicinity noticed the said actuation of the
herein respondent. Attached is the minutes of Lupon hearing dated
October 17, 2018, and marked as Annex “A”;

b.) That due to the same, respondent

______________________________ was so angry and a heated
argument ensued between us;

c.) That while having the said heated argument with the respondent, I
immediately avoided the respondent in order that the situation will not
get worst. I categorically said “ Ayaw ko makipag away sayo, ayaw
ko pumatol sa matanda at may pinag aralan akong tao. Mayroon
CCTV dito and respondent answered wala ako pakialam”. In
addition, my 6 years old daughter is with me holding my hands and to
avoid any untoward incident, I avoided the herein respondent.
Attached is the minutes of Lupon hearing dated October 17, 2018, and
marked as Annex “A”;

d.) That while I continuously avoiding any heated confrontation with the
respondent, respondent ______________________________
suddenly with intent to hurt approached me again, did then and there,
willfully, unlawfully, feloniously and maliciously, attacked me with
her fist, punched my stomach, grab my hair and hit my face with her
hand, which made me fall down on the ground while my daughter is
holding at me and crying;

e.) That said unlawful act of the herein respondent was substantially
admitted by her during the Barangay Lupon Hearing, to wit: “ Galing
ako sa tindahan ng kaibigan ko daan sa side road, andun ang
magkakaibigan 3 babae at 1 lalaki nagkaroon ng conspiracy,
nagkatapikan kami ng kamay.” Attached is the minutes of Barangay
Lupon Hearing dated October 17, 2018 and marked as Annex “B”;

f.) That due to the malicious and falsely accusations of the herein
respondent ______________________________ of Conspiracy
between my alleged friends, it resulted to her outburst emotions and
with the intent to hurt my person to his satisfaction;

g.) That in the same day October 11, 2018, I went to

______________________________ to have an examination of my
swollen face and injuries that I sustained, with the medical findings
and diagnosis of 4cm linear abrasion cheek (L), Wound between 1st
and 2nd digit (R) hand, and the attending medical doctor recommended
 for a healing and rest period of nine (9) days. Attached is the Medical
Certificate and marked as Annex “C”;

h.) That also, as a consequence of my sustained injuries to my face and

hand I was not able to work for seven (7) days. In addition, I have
suffered additional expenses of buying the medicine prescribed by the
physician. Attached is the prescription and receipt of medicine and
marked as Annex ‘D”;

i.) That on October 17, 2018, I filed a complaint before the barangay and
several hearing was conducted, the first was on October 17, 2018, the
second hearing was on October 24, 2018 and the third was on
November 07, 2018. Attached is the Minutes of Hearing and marked
as Annex “D-1, D-2, D-3” respectively;

j.) That despite several barangay conciliation hearings, no amicable

settlement was reached between the parties as evidence the Certificate
to File Action which is hereto attached as Annex “E”.

4. That I am executing this affidavit to attest to the truth of the foregoing

statements and for the purpose of charging respondent
______________________________ for the crime of Slight Physical
Injuries penalized under Art. 266 of the Revised Penal Code.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this _____ day of November 2017, San Isidro, Rodriguez, Rizal.

______________________________
Complainant/Affiant

SUBCRIBED AND SWORN TO before me this ______ day of

November 2018, Rodriguez Rizal.

______________________
Prosecutor

The undersigned Prosecutor certifies that he/she personally examined

the affiant and that she is satisfied that he voluntarily executed and
understood his complaint-affidavit.
_______________________
Prosecutor