Republic of the Philippines
MUNICIPAL TRIAL COURTS IN CITIES
10th Judicial Region
Branch 6
Cagayan de Oro City
PEOPLE OF THE PHILIPPINES, Crim. Case Nos.
Plaintiff, ________________________
-versus- For:
__________________________, Violation of B.P. Blg. 22 (8
Accused. counts)
X--------------------------------------------//
JUDICIAL AFFIDAVIT
For _______________________
(in lieu of direct testimony)
I, ________________________, of legal age, Filipino and a resident of
___________________________________, Philippines, after having been
duly sworn to in accordance with law do hereby depose and state:
PRELIMINARY STATEMENT
That in accordance with A.M. No. 12-5-8-SC, which prescribes the use
of judicial affidavits to serve as the direct examination testimony of the
witness, on the basis of which the adverse party may conduct their cross-
examination on such a witness, I hereby execute this judicial affidavit in a
question and answer format;
That conformably with section 3(b) of the said A.M. No. 12-8-8-SC, I
also state that it was _______________________, private prosecutor for the
plaintiff, who conducted the examination of the undersigned affiant at
__________________________;
That conformably also with section 3(c) thereof, I hereby state under
the pain of perjury that in answering the questions asked of me, as
appearing herein below, I am fully conscious that I did so under oath, and
that I may face criminal liabilities for false testimony or perjury;
QUESTION AND ANSWER
1. Q: What is your complete name?
A:
2. Q: What is your occupation?
A:
3. Q: Are you the same ________________________ who
executed the Affidavit of Service attached in the
complaint of ________________ against _____________ for
violation of Batas Pambansa Blg. 22?
A: Yes, I am.
4. Q: I am showing you an original copy of the affidavit of
service you have just mentioned. Kindly examine if this is
the same affidavit you were referring to?
A: Yes, that is the affidavit that I mentioned earlier. I was the
one who executed the same.
5. Q: Why did you execute the said affidavit?
A: Because I was the one who personally mailed the notice of
dishonor and demand letter through registered mail and
private courier.
6. Q: When was this notice of dishonor and demand letter
mailed?
A: I mailed the said document by registered mail with registry
return card on _________________. On the following day,
___________________, I was also the one who mailed the
document through LBC.
7. Q: I am showing you an original copy of the Registry Receipt
no. ___________________ from the Philippine Postal
Corporation and LBC Receipt with tracking no.
____________________that you have just mentioned.
Kindly examine if these are the same receipts you were
referring to?
A: Yes. That is the Registry Receipt and LBC receipt I am
referring to.
8. Q: To whom is the said document addressed?
A: It is addressed to ___________________
9. Q: What is the address indicated in the said document?
A: The address specified is ________________
No further questions.
Affiant further sayeth naught.
IN WITNESS WHEREOF, I have hereunto set my hand this
__________________, at Cagayan de Oro City, Philippines.
_________________________
Affiant
SUBSCRIBED AND SWORN to before me this ___________, at
Cagayan de Oro City, Philippines. Affiant _____________________
exhibited to me his ____________________.
Witness my hand and seal.
Doc. No. ____:
Page No.____:
Book No.____:
Series of 2018.
