Republic of the Philippines

REGIONAL TRIAL COURT

Fourth Judicial Region
Antipolo City
Branch 72

__________________,
Petitioner,

-versus- CIVIL CASE No.

__________
For: Nullity of Marriage

__________________,
Respondent.
x ------------------------------- x

JUDICIAL AFFIDAVIT
OF WITNESS

PRELIMINARY STATEMENT

I, _______________, Filipino, of legal age, with address at

_______________________, after having been sworn in
accordance with law, hereby execute this Judicial Affidavit, in
Question and Answer form, and hereby answer the following
questions below in support of the claims and allegations of
Respondent __________________, in Civil Case No.
__________ for Nullity of Marriage pending before
_______________. Consciously knowing that I am under oath,
and with understanding that I may face criminal liability for false
testimony or perjury, I hereby answer the following questions from
_____________ with office address at ________________,
who conducted this examination in her office.

IN WITNESS WHEREOF, I have hereunto affixed my

signature this ________________ at _________________.

__________________
Affiant
 SUBSCRIBED AND SWORN to before me this
_________________ at _______________. I have identified
affiant through his _______________
issued at _______________ on ______________
bearing his photograph and signature.

Doc. No. ___;

Page No. ___;
Book No.___;
Series of 2016.

ATTESTATION

I, __________, of legal age, Filipino, and with office address

at __________, under oath and state that:

1. I conducted the examination of witness, __________, on

__________, in connection with the above-captioned
case.

2. I faithfully recorded or caused to be recorded the questions

that I asked and the answers that the witness gave as stated
in his judicial affidavit.

3. Neither I nor any other person present or assisting the

witness coached him regarding his answer stated in his
Judicial Affidavit.

____________________
Affiant

SUBSCRIBED AND SWORN to before me this

______________ at _____________, affiant personally
appeared and exhibited to me her Integrated Bar of the Philippines
Identification Card with I.D. No. __________ and bearing her
photograph and signature.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2016.

Copy furnished:

__________
Counsel for Respondent
Address

THE OFFICE OF THE SOLICITOR GENERAL

134 Amorsolo St., Legaspi Village
Circumferential Road
Makati City

OFFICE OF THE CITY PROSECUTOR

2nd Floor, Hall of Justice
Antipolo City, Rizal