Republic of the Philippines

____________ Judicial Region

________________ TRIAL COURT

Branch _____, _____________, _____________

COMPLAINT

The undersigned, _____________, accuses _____________ of the crime of ACTS OF LASCIVIOUSNESS, committed as follows, to wit:

That on or about _____________, at about _________ (a.m./p.m.), in the City/Municipality of _____________, Province of _____________ and within the jurisdiction of this Honorable Court, the said accused _____________ did then and there willfully, unlawfully, and feloniously embrace the undersigned, when the latter was about to enter a public toilet, holding her breasts and taking liberties upon her person by force and against the will of the undersigned.

Contrary to law.

_____________, Philippines, __Date__.

___________________________________

COMPLAINANT

SUBSCRIBED AND SWORN TO BEFORE ME, A Notary public in and for the City of Puerto Princesa and the Province of Palawan this 24th day of October 2013. Affiant personally came and appeared with Driver’s License ID No. issued by the Land Transportation Office and valid until May 1, 2015, at Puerto Princesa City, bearing his photograph and signature, known to me as the same person who personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument

_________________________________

Notary Public

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of 20__;

Witnesses:

____________________

____________________