Republic of the Philippines

COURT
11 Judicial Region, Branch ___ City NAME OF PLAINTIFF, Plaintiff, - versus NAME OF DEFENDANT, Defendants. x---------------------x CASE NO. _____________
th

FOR: _________________

JUDICIAL AFFIDAVIT OF NAME OF WITNESS

This Judicial Affidavit of _______________ is executed to serve as his/her direct testimony in the instant case. This Judicial Affidavit is offered to prove: (1) all the allegations in the _______________; (2) including all the ANNEXES appended thereto, which he respectfully requests to be correspondingly marked as EXHIBITS in this case; and (3) all matters related thereto, with reservation to present additional exhibits in the course of the proceedings of the instant case. QUESTIONS were propounded by plaintiffs counsel, Atty. _______________, in English, which the affiant fully understands, while ANSWERS were given/made by witness _______________, , in English/Tagalog/Bisaya dialect and the corresponding translation of his answer is provided after each question,
1. Please

state your name, age, residence address, and occupation. Ans. ___________________.

2. How are you related to the defendants in this case? Ans. ___________________.

3. Please tell me how did you know the complainant in this case? Ans. ______________________________;

4. Showing you a (document), which we request to be marked as our Exhibit _____. What relation has this document to the ______________________ you mentioned? Ans. _____________________.

5. I have here with me a document which I request to be marked as Exhibit ___. Do you confirm my action? Ans. Yes.

6. Do you attest to the truthfulness of your statements and allegations in this Judicial Affidavit? Ans. Yes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this date, in place, Philippines.

Name of Witness Affiant SUBSCRIBED AND SWORN to before me this (date and place), Philippines, and I hereby certify that I have personally examined the affiant and that I am convinced that he understood and voluntarily executed this Judicial Affidavit.

Copy furnished: ATTY. ________________ Address THE CLERK OF COURT Address

ATTESTATION

I, ATTY. ______________, of legal age, single/married, and a resident of ________________, after having been duly sworn to in accordance with law, hereby depose and say, that: (1) I am the counsel of _____________ in Case No. ______________; (2) I faithfully recorded or caused to be recorded the questions I asked and the corresponding answers that the witness gave for his Judicial Affidavit; and (3) Neither I nor any other person then present or assisting him coached the witness regarding the latter's answers.

IN WITNESS WHEREOF, I have hereunto affixed my signature this (date and place), Philippines.

ATTY. __________________ Affaint SUBSCRIBED AND SWORN TO BEFORE ME this (date and place), Philippines, affiant exhibited her IBP ID No. __________ as her competent evidence of identity.

Doc No. ___; Page No. ___; Book No. ___; Series of 2013.

Notary Public