Republic of the Philippines)

Province of Eastern Samar) S.S.

Municipality of Can-avid)

AFFIDAVIT

I, KRISTINA CASSANDRA y CONCEPCION, 45 years old, married, presently

reside at Barangay X, Can-avid, Eastern Samar, after having been sworn to an oath in
accordance with law, do hereby depose and say:

1. That on April 29, 2015, at about 11:30 in the morning, more or less, I was
having a conversation with Manunulay Sabid in Barangay X, Can-avid,
Eastern Samar. The latter was sitting on her motorcycle outside our house.
Then, XXX and XXX came. An agitated XXX, without provocation, uttered
words in particular towards XXX saying in vernacular, Ayaw ako niyo
igbinulig-bulig kay waray ak hit pakialam. Makita ka hit ak kaangol hihibangon
ta ikaw ngin hingadto ka ha XXX, ayaw nala pakikita haak!;

2. Then, XXX suddenly punched XXX face repeatedly. A concerned XXX ran
towards them and restrained XXX from further inflicting injuries to XXX;

3. I am executing this affidavit to attest the veracity of the foregoing and to

support in filing a case of SERIOUS PHYSICAL INJURIES against the herein
named suspect XXX XXX before the Office of the Assistant Provincial
Prosecutor, Dolores, Eastern Samar.

IN TRUTH WHEREOF, I will affix my signature below this 30th day of April
2015 at XXX Municipal Police Station, XXX, Eastern Samar, Philippines.

KRISTINA C. CASSANDRA
Affiant

SUBSCRIBED AND SWORN to before me this ____th day of April 2015 in

XXX, Eastern Samar and I hereby certify that I personally examined the affiant and I am
satisfied that she fully understand the contents of her affidavit and that she voluntarily
executed the same

HON. DONALD TRUMP

Assistant Prosecutor II
Administering Officer