Vous êtes sur la page 1sur 3

Annex “F”:

JUDICIAL AFFIDAVIT

I, MOSCOW PACO TOUS, 35 years old, born on September 20, 1984,


single employed as waiter at ColdLegs Bewery, after having been duly sworn to in
accordance with law, hereby depose and state:

PRELIMINARY STATEMENT

That in accordance with A.M. No. 12-8-8-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 DENVER JAIME LORENTE, investigator of the Sta. Ana Police
Station who conducted the examination of the undersigned affiant;

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;

AND UNDER OATH, AVERS THE FOLLOWING:

[knowledge/information
about infliction of physical injuries]

1. Q : What are the reasons why you are voluntarily came to this Office?
A : Because I want to help my friend and our loyal customer

2. Q : If that is the case, can you tell us all your knowledge/information about
the incident?
A : Yes sir. I am a waiter of ColdLegs Brewery. On October 5, 2019 at
around 6:00 pm when the incident happened, I was serving the order of
Mr. Sergio C. Marquina when suddenly Mr. Arturo R. Roman punched
him in the face and pushed him causing Mr. Sergio C. Marquina to fall
on the floor.

3. Q : What was the reason why Mr. Arturo R. Roman committed such acts?
A : Based on what he was uttering during the incident, he was jealous of
Mr. Oslo Roberto Garcia, one of our Macho Dancers, because he was
having a good time with Mr. Sergio C. Marquina in their table.

4. Q : Why would Mr. Arturo R. Roman be jealous?

1 of 5
A : Because he regularly books Mr. Oslo Roberto Garcia everytime he goes
to our bar.

5. Q : What happened after Mr. Sergio C. Marquina fell on the floor?


A : He was assisted by his friends and they went to the Southern Philippine
Medical Center for medical examination.

6. Q : _______xxxxx OTHER CONNECTING QUESTIONS xxxxx_______


A : _________xxxxx ANSWERS xxxxx__________

7. Q : For the meantime, I don’t have further questions, do you have any
statements to add or take away on this affidavit?
A : I don’t have sir for the meantime.

8. Q : Were you threatened, promised or bribed to do this confession?


A : No sir. I made it voluntarily with my own free will.

9. Q : Are you willing to sign this affidavit consisting of six (6) pages, to
certify that all the statements you made are true.
A : Yes sir.
---------END OF STATEMENT----------

IN WITNESS WHEREOF, I hereunto set my hand below this 12th day of


October, 2019 at Davao City.

MOSCOW PACO TOUS


Affiant

SUBSCRIBED AND SWORN to before me this 12th day of October, 2019 at


Davao City. Further, I certify that I personally examined the herein affiant that he
voluntarily executed and fully understood his statements.

TOKYO URSULA CORBERO


Administering Officer

2 of 5
ATTESTATION

I, DENVER JAIME LORENTE, investigator of Sta. Ana Police Station, Davao


City, on my oath as the Investigator-on-Case (IOC), hereby depose and states:

That I have personally conducted the foregoing examination to the witness-


affiant MOSCOW PACO TOUS at Sta. Ana Police Station, Davao City;

That I have faithfully recorded and translated into English language the
questions asked of him and the corresponding answers that he gave in response to
the questions asked;

Neither I nor any other person/s coached this witness-affiant regarding the
answers given by her.

IN WITNESS WHEREOF, I hereunto set my hand below this 12th day of


October, 2019 at Davao City.

DENVER JAIME LORENTE


Investigator

SUBSCRIBED AND SWORN to before me this 12th day of October, 2019 at


Davao City. Further, I certify that I personally examined the herein affiant that he
voluntarily executed and fully understood his statements.

TOKYO URSULA CORBERO


Administering Officer

3 of 5

Vous aimerez peut-être aussi