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.
Administering Officer

Complaint Affidavit BP 22
Republic of the Philippines
)
____________________________
x-----------------------------------x

) S. S.

COMPLAINT AFFIDAVIT
I, ________________________________, Filipino, of legal age, with postal address at
_____________________________________________ , after being duly sworn in to accordance with
law, hereby depose and say:
1.

That I am filing a complaint against__________________________________ for

Estafa and for violation of BP 22, who can be served with summons and notices at
_________________________________________________________________.
2.

That sometime on _________________________ at my residence in the City of

Manila, _____________________________ convinced me to take her check for rediscounting

representing that the checks will be good on the date indicated on the checks.
3.

That the respondent delivered several checks and TWO (2) among several checks are

the subject of this case amounting to P235,000.00, to wit:

_____________________ BANK (Annex A)

03xxxxxx

May 20, 2011 P58,750.00

_____________________ BANK (Annex B)

03xxxxxx

June 20, 2011 P58,750.00

____________________

TOTAL:

P117,500.00
4.

That on the dates of the check I deposited the same and to my dismay they all came

back with annotations ACCOUNT CLOSED.

5.

That she defrauded me to part with my money when he issued a check with

insufficient funds and worse account closed. She issues checks knowing very well that the same is
worthless.
6.

That upon bouncing of the checks I PERSONALLY delivered a demand letter to the

respondent giving her a chance to make good the payments of the checks but she chose to ignore the
same.
7.

Herein attached is the Demand Letter delivered personally to the respondent on

____________, 2011 as ANNEX C.

IN WITNESS WHEREOF, I have affixed my signature this ___ day of ____________ 2011 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