Republic of the Philippines )

Province of ____________ ) S. S.
City of ______
)
COUNTER-AFFIDAVIT
I, __________________, of legal age, single, Filipino Citizen, and a resident
of ________, __________, ________, after having been sworn to an oath in
accordance with law, do hereby depose and state that:
1. I am the accused in NPS Docket No. ______________, for Reckless
Imprudence resulting to Homicide, pending before the Provincial
Prosecutors Office in __________________;
2. I deny the said charge against me;
3. On December 8, 2014, at around 7:30 AM, I went to ____________,
in _______________, to attend a class;
4. After our class, at around 10:00 AM, I and my classmates decided
to go to ___________________, to attend the barangay fiesta;
5. I and my classmate __________ decided to drive to
Br__________________, using his motorcycle;
6. Our other classmates decided to take the bus;
7. I drove slowly because my other classmates were unable to
immediately a catch a bus;
8. While driving along the National Highway, in __________________, I
noticed a lot of people in the area, as they were distributing relief
goods;
9. Upon noticing the crowd, I slowed down;
10.
Then suddenly, a woman carrying a plastic bag of rice and
holding an umbrella quickly crossed the street;
11.
The woman was not looking at the street as her view was
covered by her umbrella and her attention was focused on the
relief goods;
12.
I did not drive the motorcycle recklessly;
13.
I am a peaceful and law-abiding citizen, and I have no
criminal record;
14.
I attest to the truth of the foregoing statements to prove
my innocence of the crime charged.
IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of
February, 2015, at ___________________.
___________________
Affiant
SUBSCRIBED AND SWORN to before me this 6th day of February,
2015, at ____________________.
______________________

Doc. No. _____

Page No. _____
Book No. _____
1

Series of 2015