FORM NO.

47
Judicial Affidavit

REPUBLIC OF THE PHILIPPINES

NATIONAL CAPITAL JUDICIAL REGION
REGIONAL TRIAL COURT
BRANCH _______, MAKATI CITY

_______________________
Plaintiff,
— versus — CIVIL CASE NO._________________
FOR: SUM OF MONEY
______________________
Defendant.
X______________________________x

JUDICIAL AFFIDAVIT OF
(name of witness)
Name of Witness: (state name and personal circumstances of witness)
Name of lawyer conducting the examination: (state name of lawyer conducting
the examination/ interview of the witness, office address) is the counsel on record
for the _________.
Date & Place where examination was held: (state date(s) and place where
examination was conducted)

OFFER OF TESTIMONY:

Atty. ___________ (To the Honorable Court): We are offering the testimony of the
witness (state name of witness) to prove:
(1) (state the purposes for which the testimony of the witness is being
offered) xxx and all other material allegations in the complaint.
In the course of his testimony, the witness will identify the documentary and
object evidence of the plaintiff which are attached to this Judicial Affidavit.
The testimony of plaintiff’s witness was reduced to Judicial Affidavit,
pursuant to A.M. No. 12-8-8-SC (Judicial Affidavit Rule), and which Judicial
Affidavit will serve as his direct testimony in this case.
QI. Do you swear to tell the truth, the whole truth and nothing but the truth in this
sworn statement that you are about to make? A— Yes, Attorney, I do.
Q2. Your testimony is under oath and in case your statements are found to be
untrue, you may be held criminally liable for false testimony or perjury, Do
you understand that?
A— Yes, Attorney.
Q3. Do you know the plaintiff in this case?
 A— Yes, Attorney,
Q4. Why do you know plaintiff?
A •xxx xxx xxxx
(After a document is identified by the witness, request that the same be
marked)
Atty ______: Your Honor, may we request that this (state nature and date of
document) identified by the witness be marked as Exhibits "A:
Q5 xxx xxx xxx
A, xxx xxx xxx
Atty. _________: That is all for the witness, Your Honor.
IN WITNESS WHEREOF, 1 have hereunto affixed my signature this
_____20 _____ at __________________.

Signature of Affiant-Witness

JURAT

(Signature and Seal of the Notary Public)

(FORM NO. 1)

ATTESTATION
I, (name of lawyer who conducted examination of the witness; and office
address), do hereby attest that on the date and place above-stated:

1. I have personally examined the witness, (name of witness).

2. I have faithfully recorded or caused to be recorded the
questions asked and the corresponding answers thereto made by him.
3. I further attest that I or any other person herein present, or
assisting me, never coached the said witness regarding his answers.
for

(Name and signature of Lawyer-affiant)

Roll of Attorney
IBP number; date and place issued
PTR number; date and place issued MCLE
Comp./Exemp No.; date issued

JURAT
(Signature and Seal of the Notary Public)
(FORM NO. 1) Copy

Furnished: (by personal service or private courier)

Atty. _________
Counsel for the _______
Address:_______