Republic of the Philippines )

Province of )S.c.
Municipality of )

AFFIDAVIT OF WAIVER OF ARTICLE 125

OF THE REVISED PENAL CODE

I, jkjfbjkdnkE, 48 years old, Filipino, married, and a resident of Philippines, under

oath declare:

That I am under the custody of the police authorities of Municipal Police Station of
______, since past 4:00 P.M., more or less, of June 29, 2021 for the alleged crime of
Violation of RA 9516 amending Sec. 3 of PD 1866 and RA 10591 in the case of _______
docketed as NPS No. _______;

That I opted to avail of my statutory right to preliminary investigation instead of

immediately filing a case in court as an inquest case;

That as such, I hereby waive whatever legal effects and consequences provided for
under Article 125, Revised Penal Code, as amended, in the presence and assistance of Atty.
___________, , freely, and voluntarily without any vice of consent;

That with the execution of this WAIVER, I fully understand that I will remain in
detention under police custody without them incurring any criminal liability;

That I execute this freely and voluntarily to attest to the veracity of the foregoing
statement.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 01 July 2021 at

_____, Philippines.

GVHJJbjknk
Affiant

SUBSCRIBED AND SWORN to before me this 01 July 2021 at ____ Philippines.