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Complaint

1. Romeo Datu filed a complaint against Johnny Martia for serious physical injuries. 2. Martia severely beat Datu with a wooden plank, fracturing his leg and breaking two ribs. 3. Datu was hospitalized for 16 days and required 4 weeks of rest to recover from his injuries.

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Mark Villanueva
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117 views2 pages

Complaint

1. Romeo Datu filed a complaint against Johnny Martia for serious physical injuries. 2. Martia severely beat Datu with a wooden plank, fracturing his leg and breaking two ribs. 3. Datu was hospitalized for 16 days and required 4 weeks of rest to recover from his injuries.

Uploaded by

Mark Villanueva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES}

DONE: IN THE CITY OF SANTIAGO} S.S.

X =========================== X

COMPLAINT-AFFIDAVIT

1. I, ROMEO F. DATU, 27 years of age, single, a resident of 47 Naguillian, Santiago City


after havingbeen sworn to in accordance with law, do hereby depose and state:1.

2. That on January 7, 2013 at around 6o’clock in the evening while I was heading home
fromthe cemetery, I met JOHNNY M. MARTIA, a resident of 7 Lourdes Subdivision, at the
corner of Dominican Rd.2.

3. That without warning, he suddenly attacked me with a 2x2 piece of wood while saying
layuanmo sya! akin sya;3.

4. That despite being gripped to stop by the bystanders nearby, he still kept on attacking
mewhile shouting mang-aagaw ka ;4.

5. That due to the said incident, I suffered a 10-inch wound in my head, a fractured left leg
andtwo broken ribs due to the severe beating, and has been hospitalized for 16 days and
advisedto a complete rest for 4 weeks or more until my leg brace will be removed and
my ribs will becompletely healed.5.

6. I am executing this complaint-affidavit in order to file a case of Serious Physical Injuries


against JOHNNY M. MARTIA.AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 14th day of February 2013, at Santiago
City, Philippines.

ROMEO F. DATU
Affiant

SUBSCRIBED AND SWORN to before me in the City of Santiago this 14th


day of February 2013. I hereby certify that I have personally examined the above named affiant
and that I am satisfied that the foregoing statements were given by her voluntarily and of his
own free will.

_______________________
Investigating Prosecutor
(KP Form No. 20)

Republic of the Philippines


Province of Isabela
City of ______________
Barangay _______________________

OFFICE OF THE LUPONG TAGAPAMAYAPA


======================================================================

_______________________________ Barangay Case No. _____________________


_______________________________ For: __________________________________
__________________________________ Complainant/s -against-
___________________________ ___________________________ Respondent/s
CERTIFICATION TO FILE ACTION This is to certify that:

1. There has been a personal confrontation between the parties before the Punong
Barangay/Pangkat ng Tagapagkasundo;

2. An amicable settlement/ agreement to arbitrate was reached;

3. The settlement/agreement has been repudiated in a statement sworn to before the Punong
Barangay by ____________________ on ground of _________________; and

4. Therefore, the corresponding complaint for the dispute may now be filed in
court/government office.

This ______ day of __________________, 20___. ________________________

______________________
Lupon Secretary

Attested:

________________________
Lupon Chairman

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