LEGAL WRITING (SATURDAY; 10:00 AM - 12:00 NN, FCJ 102)

GROUP IX – Affidavit of Desistance / Affidavit of Accident / Promissory Note

REPUBLIC OF THE PHILIPPINES)

CITY OF PASAY ) S.S.

AFFIDAVIT OF DESISTANCE

I, THEODORE V. MOULIN, of legal age, Filipino, Married, and a resident at 1306 Taft Avenue,
Corner Menlo St., Pasay City, after having duly sworn to in accordance with law hereby depose and
state:

1. That, I am the complainant against SAN GOKU in the case entitled "People of the
Philippines versus San Goku", Criminal Case No. 12121, for SERIOUS PHYSICAL INJURIES
pending before the Metropolitan Trial Court, Branch No. 46, Pasay City;

2. That, after carefully re-examining the facts, I realized that because I was not wearing my
eyeglasses and that it was dark, I cannot identify without doubt the person/s who
inflicted harm against me;

3. That, since I could not state with certainty the liability of SAN GOKU, I am withdrawing
my complaint for Serious Physical Injuries in Criminal Case No. 12121 in
the Metropolitan Trial Court, Branch No. 46, Pasay City;

4. That, I am executing this Affidavit of Desistance out of my own free will;

5. That, I am fully informed of the consequences of executing this affidavit, and that I can
no longer file a case against SAN GOKU over the same incident.

IN WITNESS WHEREOF, I hereby set my hand this 15th day of September 2019 in Pasay City.

____________________
THEODORE V. MOULIN
Affiant

SUBSCRIBED AND SWORN to before me this 16th day of September 2019 in Pasay City, I HEREBY
CERTIFY that I have personally examined the affiant and am satisfied that she voluntarily executed
and understood her affidavit.

_____________________
RONALDO M. DELA ROSA
Public Prosecutor

AFFIDAVIT OF DESISTANCE - An affidavit wherein the complainant states that it is not his/her
intention to institute a case and that he is no longer interested in testifying or prosecuting. This is
only a ground for dismissing the case when the prosecution can no longer prove the guilt of the
accused beyond reasonable doubt without the testimony of the complainant.

GROUP IX:
(1) SALAMIDA, RAYMART SABARILLO (3) SAN ABRIEL, ADAMS TOM JUATCHON
(2) LLENARESAS, MONICA KRISTINE MACASINAG (4) MADRID, MA. LUISA CASHELLE PULLON
LEGAL WRITING (SATURDAY; 10:00 AM - 12:00 NN, FCJ 102)
GROUP IX – Affidavit of Desistance / Affidavit of Accident / Promissory Note

REPUBLIC OF THE PHILIPPINES)

CITY OF PASAY ) S.S.

AFFIDAVIT OF ACCIDENT

I, THEODORE V. MOULIN, of legal age, Filipino, Married, and a resident at 1306 Taft Avenue,
Corner Menlo St., Pasay City, after having duly sworn to in accordance with law hereby depose and
state:
1. That, I am the registered owner of a Lamborghini Aventador SVJ Roadster which is
particularly described as follows:
O.R. No. : 546987123 dated 09.17.2019
C.R. No. : 321654987 dated 09.17.2019
Engine No. : AGZU3614621
Chassis No. : KZBLK4587318351358
Mv File No. : 1011-10000001775
Plate No. : FCJ 0102

2. That, around 21:00 of September 31, 2019, I drove the said vehicle going to 168 Mall
Divisoria to buy a pen for my crossword puzzles. The parking was full so I properly parked
the said vehicle alongside the road in the back area of the mall;

3. That, when I came back from the mall, I noticed that the vehicle already had dents and
scratches on the bottom portion of the passenger side rear door, it must have been hit by
other passing vehicles;

4. That, all incidents herein stated were purely accidental resulting to damages on the vehicle;

5. That, I am executing this affidavit to attest to the veracity of the foregoing statements and
for the purpose of claiming the damage from the insurance company.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 31st day of September 2019 in
the City of Pasay, Philippines.

____________________
THEODORE V. MOULIN
Affiant

SUBSCRIBED AND SWORN before me this 31st day of September 2019 in the City of Pasay, Philippines
by Theodore V. Moulin exhibited to me his Drivers License No. 123-45-5677910 issued on September
17, 2019 at Pasay City, Manila.
Notary Public
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 2019;

AFFIDAVIT OF ACCIDENT – An affidavit commonly used to file claims for remuneration or

recuperation of a damage cause by unintentional circumstances. This may also be used as valid
testimonies for parties involved in an accident.
GROUP IX:
(1) SALAMIDA, RAYMART SABARILLO (3) SAN ABRIEL, ADAMS TOM JUATCHON
(2) LLENARESAS, MONICA KRISTINE MACASINAG (4) MADRID, MA. LUISA CASHELLE PULLON
LEGAL WRITING (SATURDAY; 10:00 AM - 12:00 NN, FCJ 102)
GROUP IX – Affidavit of Desistance / Affidavit of Accident / Promissory Note

PROMISSORY NOTE

FOR VALUE RECEIVED, I promise to pay Bushta Papasatayo the amount of Ten Thousand Pesos
(P10,000.00) payable in five annual installments plus interest of six percent per annum as follows:

P 2,000.00 on the 17th day of September 2020;

P 2,000.00 on the 17th day of September 2021;

P 2,000.00 on the 17th day of September 2022;

P 2,000.00 on the 17th day of September 2023;

P 2,000.00 on the 17th day of September 2024;

This financial instrument is issued this 17th day of September, at Pasay City.

___________________ ___________________
BUSHTA PAPASATAYO THEODORE V. MOULIN
Creditor Debtor

PROMISSORY NOTE – A financial instrument that contains a written promise to pay another party a
certain sum of money at a specified date or on demand.

GROUP IX:
(1) SALAMIDA, RAYMART SABARILLO (3) SAN ABRIEL, ADAMS TOM JUATCHON
(2) LLENARESAS, MONICA KRISTINE MACASINAG (4) MADRID, MA. LUISA CASHELLE PULLON