Republic of the Philippines

MUNICIPAL TRIAL COURT

Branch 3, Bayugan City

PEDRO SY

Plaintiff, CRIM. CASE NO. 2626181995

FOR: SLIGHT PHYSICAL

INJURIES

- Versus -

JORGE DY

Defendant,

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JUDICIAL AFFIDAVIT

I, PEDRO SY, of legal age, married, and living at Apolinario Heights, Bayugan City plaintiff
in this case, state under oath as follows:

PRELIMINARY STATEMENT

The person examining me is Atty. Rey Yu with address at The examination is being held at the
same address. I am answering his questions fully conscious that I do so under oath and may face
criminal liability for false testimony and perjury.
 Direct Examination Questions

Q1. Do you know Jorge Dy, the defendant in this case?

A1: Yes, I know him sir.

Q2: How did you know him?

A2: He was my girlfriends bestfriend.

Q3: Where did this incident happened?

A3: At Gaisano Mall in Bayugan City.

Q4: When did this occur?

A4: On December 23, 2016 sir.

Q5: Where did he punch you?

A5: In the eyes and at my stomach sir.

Q6: How many times?

A6: 3 times in the eyes and 5 times in my stomach.

Q7: Were you able to fight back?

A7: No sir.

Q8: Why?

A8: Because he tied my hands with his necktie.

Q9: What is your proof that his punches were the cause of your injuries?

A9: I have a medical report from the hospital.

Q10: Is this medical report made in writing?

A10: Yes, sir.

Q11: Where is this medical report you mentioned?

A11: This is the one, sir. (handling over a document)

Q12: I am marking this medical report as exhibit A and the bracketed signature above the name
Dr. Mendez to your judicial affidavit. Do you confirm my action?

A12: Yes sir.

Q13:Do you have something more to say, to add or to change your answers in this affidavit?

A13: No more, sir.

IN WITNESS WHEREOF, I hereunto affix my signature this 2nd day of January 2017
in Bayugan City, Philippines.

PEDRO SY

Affiant

SUBSCRIBED AND SWORN to me before this 2nd day of November 2016 at Baygan
City, Agusan del Norte , Philippines. I hereby certify that I personally examined the affiant; that
he has voluntarily, knowingly and intelligently executed the foregoing and that he fully
understands it contents.

ATTY. JIRAH GRACE CHEE

NOTARY PUBLIC UNTIL JULY 18, 2018
Doc. No. ____; PTR No. 12345678
Page No. ____; IBP No. 18144; Roll No. 123
Book No. ___; MCLE Compliance No. 1243
Series of 2016 TIN-123-13434-434

SWORN ATTESTATION

faithfully recorded the questions I asked and the answers he gave; and neither I, nor any other
person then presents coached Mr. Ricardo L. Dalisay regarding his answers.

ATTY. JIRAH GRACE CHEE

Affiant

SUBCRIBED AND SWORN to before me this 1st day of January 2017 at Bayugan City,
Philippines, by affiant above who executed and signed the foregoing Judicial Affidavit in my
presence and I further certify that the affiant has fully understood the contents of his affidavit
and that he executed the same voluntarily and intelligently.

ATTY. Oscar Dy
NOTARY PUBLIC UNTIL August 18, 2018
Doc. No. ____; PTR No. 12345678
Page No. ____; IBP No. 18144; Roll No. 123
Book No. ___; MCLE Compliance No. 1243
Series of 2016 TIN-123-13434-434