Republic of the Philippines

REGIONAL TRIAL COURT

7th Judicial Region
Branch __
Dumaguete City

AAAA Civil Case No. ________________________

Plaintiff,
For: ______________________
-versus-

BBB AND CCC,

x----------------------------------------------/

JUDICIAL AFFIDAVIT

I, AAA, of legal age, Filipino, married and currently residing in ______ , plaintiff
in this case, state under oath as follows:

The person conducting and supervising my examination as a witness is

Atty. DDD at her office address at ;

That I am answering the questions herein fully conscious that I do so under

oath and that I may face criminal liability for false testimony or perjury.

1. Q. Do you swear to tell the truth and nothing but the truth?
A. Yes Ma’am.

2. Q. Are you aware that you may face criminal liability for false
testimony or perjury if you will not tell the truth?
A. Yes Ma’am.

3. Q. Please state your name and other personal circumstances for the
record.
A. I am AAA, of legal age, Filipino, married and currently residing in
______

4. Q. Are you the same AAA, the plaintiff in this case?

A. Yes Ma’am.

5. Q. What is your reason in coming to this office?

A. I am here to execute a Judicial Affidavit…

6.
7.
8.
9.

1
10. Q. Are you willing to sign your affidavit to attest to its truthfulness?
A. Yes Ma’am.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________________ at ____________________________ Philippines.

AAA
Affiant
___________________________

SUBSCRIBED AND SWORN to before me, this ___ of July 2020 at _______________,
Philippines, affiant exhibiting to me his proof of identification as indicated
below his written name.

Doc. No. ______ ;

Page No. ______ ;
Book No. ______ ;
Series of 2020

ATTESTATION

I hereby state, under oath, that I faithfully recorded the questions I asked and
the corresponding answers that the witness gave and that neither I nor any
other person present or assisting me has coached the witness regarding the
latter’s statement.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________________

at ____________________________, Philippines.

ATTY. DDD

SUBSCRIBED AND SWORN to before me, this ___ of July 2020 at

_________________, Philippines. The examining lawyer is personally known to me
to be the person executing this attestation.

Doc. No. ______ ;

Page No. ______ ;

2
Book No. ______ ;
Series of 2020