The undersigned, _____________, accuses _____________ of the crime of LIBEL, 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, being then the Editor-in-Chief and Publisher of the newspaper _____________, which is a newspaper of general circulation in the Philippines, did then and there, voluntarily, unlawfully, feloniously, and with the intention to cause dishonor, discredit, contempt and ridicule on the person of one _____________, write, compose, print, and publish in the _____________ issue of the said newspaper a highly defamatory article in words as follows:
(Quote the Defamatory Article)
Contrary to law.
_____________, Philippines, __Date__.
(Certification of Preliminary Investigation)