Sunteți pe pagina 1din 4

REPUBLIC OF THE PHILIPPINES

CITY PROSECUTION OFFICE


Iloilo City

DOS A. MARIAS
Complainant,

versus For: Slight Physical Injuries

TRES A. MARTIRES
Respondent.
x - - - - - - - - - - - - - - - - - - - - - - - -x

COMPLAINT-AFFIDAVIT

THE UNDERSIGNED COMPLAINANT respectfully alleges:

I, DOS A. MARIAS, Filipino, of legal age and a resident of #4 Kilid


St., Lapaz, Iloilo City, after having been duly sworn to in accordance
with law, do hereby depose and state that:

1. I am filing a case of slight physical injuries against TRES A.


MARTIRES of #3 Likod St., Lapaz, Iloilo City.

2. On January, 2023 at around 7 p.m. I went to Martires’ house to talk


to him regarding some problems at the Lapaz tricycle terminal. We are
both members of the tricycle drivers’ association. However, Martires
upon seeing me, got mad and asked me to leave.

3. To avoid trouble, I boarded my tricycle and prepared to leave. At this


juncture, Martires came running towards me and without any warning
punched me thrice on the face. Fortunately, there were other tricycle
drivers within the vicinity who immediately pacified Martires.

4. On my part, I proceeded to a nearby Public Clinic for medical check-


up. According to the medical certificate issued by the doctor who

1 of 4
attended to me, I suffered contusions and it would take a period of
seven (7) days for them to heal.

5. The incident was referred to the barangay for conciliation


proceedings but no settlement had been reached as Martires failed or
refused to obey the summons sent to him. Hence, I was issued a
certificate to file action by the barangay.

6. In view of the foregoing, I am executing this affidavit to support the


filing of a criminal case for slight physical injuries against Tres A.
Martires.

IN WITNESS WHEREOF, I have hereunto affixed my signature this


1st day of February 2023 at Iloilo City, Philippines.

DOS A. MARIAS
Affiant

SUBSCRIBED AND SWORN to before me this 1st day of February


2023 at Iloilo City, Philippines. Affiant exhibited to me his Driver’s
License bearing number 1234-7890 containing his picture and
signature as competent evidence of his person.

ATTY. ISIDORE T. TAROL III


Notary Public
Valid until December 31, 2023
Roll of Attorneys No. 753000
PTR NO. 12345-753, Iloilo City, June 27, 2023
IBP NO. 753-12345, Iloilo City, June 27, 2023
MCLE Compliance. No. IV-12345-7530

2 of 4
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF ILOILO ) SS.
x----------------------------x

VERIFICATION AND CERTIFICATION


AGAINST NON- FORUM SHOPPING

I, DOS A. MARIAS, of legal age, after being duly sworn to in


accordance with law, depose and attest:

1. I caused the preparation of the foregoing complaint;

2. I have read the contents thereof and the facts stated therein are
true and correct of my personal knowledge and/or on the basis
of copies of documents and records in my possession;

3. I have not commenced any other action or proceeding involving


the same issues in the Supreme Court, the Court of Appeals, or
any other tribunal or agency;

4. To the best of my knowledge and belief, no such action or


proceeding is pending in the Supreme Court, the Court of
Appeals, or any other tribunal or agency;

5. If I should thereafter learn that a similar action or proceeding


has been filed or is pending before the Supreme Court, the
Court of Appeals, or any other tribunal or agency, I undertake
to report that fact within five (5) days there from to this
Honorable court.

3 of 4
IN WITNESS WHEREOF, I have hereunto set our hand this
1st day of February 2023, Iloilo City.

DOS A. MARIAS
Affiant

SUBSCRIBED AND SWORN to before me this 1st day of February


2023 at Iloilo City, Philippines. Affiant exhibited to me his Driver’s
License bearing number 1234-7890 containing his picture and
signature as competent evidence of his person.

ATTY. ISIDORE T. TAROL III


Notary Public
Valid until December 31, 2023
Roll of Attorneys No. 753000
PTR NO. 12345-753, Iloilo City, June 27, 2023
IBP NO. 753-12345, Iloilo City, June 27, 2023
MCLE Compliance. No. IV-12345-7530

Doc. No. 15;


Page No. 4;
Book No.1;
Series of 2023

4 of 4

S-ar putea să vă placă și