(Complaint-Affidavit for Filing of B.P. 22 Case)

COMPALINT-AFFIDAVIT

I, _________________, of legal age, Filipino, (single / married / widow), and a resident of _______________, Philippines, after being sworn in accordance with law, hereby depose and state:

1. That I know the person    Respondent   , who is a resident ______________, Philippines;

2. That sometime in the morning of    date of issue   , at    place of issue   , Philippine, the said    Respondent   , issued in my favor a    Name of Bank   , Check No. _____________ in the amount of P ____________ as supposed payment for the loan accommodation of P ____________, which I have extended to (him/her);

3. That the said check is drawn against the account of the said    Respondent    at    Name of Bank    with Account No. _____________;

4. That at the time the said    Respondent    issued the delivered the said check to me, (he/she) made the assurance and representation that the said check is a good check and would be covered by sufficient funds when presented for payment;

5. However, when the above-mentioned check was deposited, the same was dishonored and returned by the bank on the ground that the same was drawn against a “CLOSED ACCOUNT.” A true and faithful machine reproduction of the said check is hereto attached as Annex “_____”;

6. As such I immediately notified said    Respondent    of the dishonor and return of the said check and demanded from (him/her) that (he/she) make good the said check within ______________ (_____) days from receipt thereof. A true and faithful machine reproduction of my demand letter to (him/her) is hereto attached as Annex “_____”;

7. When said    Respondent    failed to heed my demands, I endorsed the said check to my legal counsel who immediately sent a formal demand letter through registered mail with return card on _____________, which was received by the said    Respondent    on _____________. As of date however,    Respondent    has unjustifiably ignored all these demands to pay the said account and/or to redeem the said returned check. A true and faithful machine reproduction of my demand letter to (him/he) is hereto attached as Annex “______”;

8. I am therefore executing this Complaint-Affidavit in support of the charges for Violation of Batas Pambansa Bilang 22 against the said    Respondent   , who may be served with subpoena and other processes of this Honorable Office at (his/her) last known address at ______________, Philippines;

IN WITNESS WHEREOF, I have hereunto set my hands this _____________, at ______________, Philippines.

                                                                       COMPLAINANT

            SUBSCRIBED AND SWORN to before me this _______________ at _____________. I hereby certify that I have examined the Affiant and that I am fully satisfied that (he/she) has voluntarily executed and understood the contents of (his/her) Complaint-Affidavit.

                                                                                    Administering Officer

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