(Complaint Affidavit for Filing of BP 22 Case)

COMPLAINT-AFFIDAVIT

I, _____________, Filipino, of legal 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 issue__, at __place of

issue__, Philippines, 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);

That the said check is drawn against the account of the said
__Respondent__ at __Name of Bank__ with Account No.
_____________;

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;

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 "____";

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 "____"

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/her) is hereto
attached as Annex ____"

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 hand 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.