REPUBLIC OF THE PHILIPPINES

Metropolitan Trial Court

National Capital Judicial Region
Makati City
Branch ________

PEOPOLE OF THE PHILIPPINES,

Plaintiff,

-versus- CRIM. CASE NO.___________

For: Viol. of Art. 125

John Doe,
Accused.
x---------------------------------------------------x

JUDICIAL AFFIDAVIT
Direct testimony of ___________
In the form of Question and Answer

This Judicial Affidavit was given by ___________________, of legal age, Filipino, and
residing at ________________________________________________________.

The Judicial Affidavit was given by the private complainant/affiant before the Public
Prosecutor, in English, a language which he knows and fully understands at the Prosecution
Office, 15th Flr. New Makati City Hall, Makati City.

This Judicial Affidavit will constitute and serve as his direct testimony pursuant to
Administrative Matter No. 12-8-8-SC otherwise known as the Judicial Affidavit Rule

That the private complainant/affiant answered the questions asked of him/her fully
conscious that he/she does so under oath, and that he/she may face criminal liability for any false
testimony or perjury contained therein.

Manifestation: the testimony of the witness is being offered for the following purposes:

1. To prove the allegations in the complaint.

2. To establish the following: that on ______________ at about ________ am/pm, the
accused, to wit: ___________________
3. The witness will testify on all other matters which may be relevant to the case,
identify the parties involved and will also identify documents pertinent thereto.

1. Q: Please state your full name, address, occupation, and other personal circumstances, for
the record?
A:

2. Q: Mr. Witness, do you know the accused in this case? Kindly identify him if he/she is
present in court.
A:

3. Q: Do you remember executing any document in relation to the instant case?

A:
 4. Q: I am showing you a ______page Salaysay dated ________. Is this the same document
you are referring to?
A:

5. Q: Theres a signature on the ____page on top of the name, whose signature is this?
A:

Manifestation and Marking:

Your Honor, the witness identified and handed over to the Public Prosecutor a copy of the
document dated _______________ and we request that said document attached to the records be
accordingly marked as Exhibit , and the signature be marked as Exhibit for the prosecution.

6. Q: Why did you execute such document?

A:

7. Q: Do you recall where were you on __________ at around in the ____________?

A:

8. Q: Will you tell this Honorable court what you were doing at that particular date and
time?
A:

9. Q: While you were there, do you recall any unusual incident that happened?
A:

10. Q: when said incident happened, who were with you, if any?
A:

11. Q: According to you, on March 14, 2014 at about 4pm, you were arrested for shoplifting,
what happened next, if any?
A:

12. Q: After you were brought to the police station, what happened next, if any?
A:

13. Q: Accordingly to you, both accused approached you. What happened next, if any?
A:

14. Q: For how long were you detained?

15. Q: According to you, you were detained at the police station and it was only on March
17, 2014 or three days after you were arrested that you were brought to the prosecutors
office for inquest proceedings? Is that correct?
A:

16. Q: After the inquest proceedings, what happened next, if any?

A:

17. Q: do you affirm the truth and veracity of your Salaysay?

A:

Counsel: That will be all for the witness, you Honor.

I have executed this Judicial Affidavit in order to attest to the truth of the foregoing and
as part of my direct testimony in the above-captioned case.
 IN WITNESS WHEREOF, I have hereunto affixed my signature this ______ day of
November 2014 in Makati City.

Witness-Affiant

SWORN ATTESTATION

I, _____________________ of legal age, Filipino, Public Prosecutor and with office

address at 15th Flr. New Makati City Hall, Makati City, under oath, hereby depose and state:

1. I am the Public Prosecutor assigned to the MTC, Br. _______.

2. I conducted and supervised the examination of _________________ of whose herein
Judicial Affidavit is being offered in lieu of his/her direct testimony in the foregoing
criminal case entitled ___________________________.
3. I attest that I faithfully recorded or caused to be recorded both the questions propounded
upon the witness, _____________ and the corresponding answers he gave. I further
attest that I and/or any other person or assisting me at that time did not coach or influence
the witness as to his given answers.
4. I am well aware that, under Administrative Matter No. 12-8-8-SC, any false attestation
shall subject me to disciplinary actions, including the disbarment.
5. I attest to the truth of the foregoing statements, in compliance with law and for whatever
legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affix my signature below on this

_______day of November 2014 in Makati City.

Affiant

SUBSCRIBED AND SWORN to before me, on this __________ day of November

2014 in Makati City; affiant having personally appeared before me and exhibited competent
proof of her identity in the form of a Passport with No. ____________________ bearing his/her
picture and signature, and duly issued by the Department of Foreign Affairs on
_________________.

FURTHER, I hereby certify that I have personally examined the affiant and I am
satisfied that he willfully and voluntarily executed the foregoing Judicial Affidavit, and that he
read and understood the contents thereof.

Doc. No.
Page No.
Book No.
Series of 2014.

AMAV/