The undersigned, _____________, accuses _____________ of the crime of adultery, 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 voluntarily, unlawfully, and feloniously had sexual intercourse with her co-accused _____________, who is not her husband, and the latter knowing her to be married to _____________, voluntarily, unlawfully, and feloniously had carnal knowledge with her.
Contrary to law.
_____________, Philippines, __Date__