9616 )

R esolution N o. j Page 25 of 25
General Instructions for the Im plem entation of R esolution N o. 9476 as am ended

[Affidavit template of Photographer/Videographer attesting to the circumstances under which the

photographs or videos were taken]
Annex "F"
Republic of the Philippines )
City o f ________________ ) S.S.

A f f id a v it

I, (nam e of photographer/videographer') , of legal age and residing at

(address)__________________ , after having been duly sw orn to according to
law hereby dep ose and state that:

1. On (date) at (time) , I w as at the (location w here the

p h o to g ra p h /v id eo w as taken and the reason why
photographer/videographer w as at the said location);

2. I saw (description of the a cts/o m issio n s that constitute the election

offense) and took photographs/recorded the p roceed in gs/in cid en t as
they occurred;

3. [description/explanation of the photographs/videos and identification of the

subjects captured therein]

4. The p h o tog rap h s/v id eos that I have taken are accurate depictions of the
events sough t to be portrayed.

5. K now ing the sam e acts/o m ission s are unlaw ful, I reported the same to
the (election officer's nam e and p osition /area of assignm ent) and
provided h im /h e r w ith a copy of the p h otograp h s/vid eos.

6. I am executing this affidavit freely and voluntarily to attest to the truth of

the foregoing circumstances and the authenticity of the
p h oto g ra p h s/v id eo s being subm itted to support the com plaint filed
against (name of respondents) by (name of complainant) .

I have hereunto set m y hand this _ _ _ o f __________________ , 2013, at the

City o f _____________________ .

(Signature of Affiant)
[Name of Affiant]
AFFIANT

SUBSCRIBED A N D SWORN to before m e, t h i s ____ day o f _____________ ,

2013 by (name of affiant) w h o exhibited to m e h is /h e r (com petent evidence of
identity) w ith n u m b er_____________ , issued at (issuing agency and its location) ,
Philippines on (date of issue) , w ith date of expiry o n ____________.

NOTARY PUBLIC
Doc No.
Page No.
Book No.
Series of 2013.