Republic of the Philippines

MUNICIPAL CIRCUIT TRIAL COURT

_______________, Angeles

PEOPLE OF THE PHILIPPINES

Plaintiff, CRIM. CASE NO. ________
FOR: SLIGHT PHYSICAL INJURIES
-versus-
Juan Dela Pena
Defendant,
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Republic of the Philippines)

Angeles City, Pampanga ) S.S.

JUDICIAL AFFIDAVIT

I, JULIO LAPUZ y TATAD, of legal age, residing at Angeles City after having
duly sworn to in accordance with law do hereby depose and state; that,

1. Where were you on the 10th day of July 2018 at 3 oclock in the afternoon?
I was in front of 7-11 Angeles City, along Mcarthur highway near Holy Angel
University.

2. What were you doing on that particular time and place?

I was waiting to board a jeepney as I was on my way home from work.

3. Was there any unusual incident that occurred on 10 th day of July 2018 at 3
oclock in the afternoon?
There was.
4. What was that unusual incident that occurred?
I saw Juan Dela Pena, our neighbor, who appeared to be drunk
approaching me. He then started shouting at me for no reason and hit
me with his fist several times on my face.
5. What happened next?
He then ran away as some bystanders came to my rescue.
6. Did you report the incident to the police?
No.
7. After the incident, did you seek medical intervention?
Yes. I immediately went to seek medical intervention at Angeles Hospital as my face
wouldn’t stop profusely bleeding from the injuries inflicted by Juan Dela Pena.
8. Do you have a copy of your medical certificate?
 Yes. I have secured a copy of my medico-legal.

9. Do you have grudges against the accused?

I do not bear any grudge or ill will against the accused.

10. Were you forced to testify against the accused?

No.

11. Will you be able to identify the accused inside this court room?
Yes.

IN WITNESS WHEREOF, I hereunto affix my signature this _______ day of

__________ 2012 Cebu City, Philippines.

____________________________
Affiant

SUBSCRIBED AND SWORN to me before this _____ day of __________ 2012

at __________, Cebu, Philippines.

____________________________
Officer in charge