Republic of the Philippines

6th Judicial Region Regional Trial Court Branch __- Bacolod City -o0o________________ Petitioner, -versus_________________, Respondent. x- - - - - - - - - - - - - - - - - - - x JUDICIAL AFFIDAVIT a! ______________, o" legal age, #ili$ino, single and residing at __________________________. a! one o" the %itnesses "or the &etitioner in this case and state under oath as "ollo%s: PRELIMINARY STATEMENT The $erson exa!ining !e is ATTY. _______________, %ith o""ice address at __________________________. The exa!ination is 'eing held in the sa!e address. a! ans%ering his (uestions "ully conscious that do so under oath and that !ay "ace cri!inal lia'ility "or "alse testi!ony and $er)ury. EXAMINATION PROPER 1. Atty. _______: Are you the same __(name of petitioner)__ who filed the Petition entitled _____________ v. ____________ and docketed as Civil Case No. ________ efore !ranch ___ of the Re"ional #rial Court in !acolod City$ Witne : *es, a! the sa!e _______ %ho "iled the said case in court. Case No.:___________

!. Atty. ________: %o you know the Respondent$ Witne : *es, +ir. "irst !et hi!,her ______. _______________________________ -. other essential (uestions .. /. 6. 0. 1 N TR2T3 4N5 6 TN7++ 637R78#, a! here'y setting !y hand this ___________in Bacolod City, &hili$$ines.

________________ Affiant .5. No. ___________ B7#8R7 97, on ______________in Bacolod City, &hili$$ines, a""iant $ersonally a$$eared and sho%ed his a'ove-indicated co!$etent $roo" o" identity.

5oc. No. ______: &age No. ______: Boo; No. ______: +eries o" <0=-. SWORN ATTESTATION OF EXAMININ" LAWYER , ATTY. _______________, the exa!ining la%yer o" the a""iant in this Judicial 4""idavit, a"ter having 'een duly s%orn to in accordance %ith la%, here'y execute this s%orn attestation, to %it: "aith"ully recorded the (uestions as;ed o" the a""iant and the corres$onding ans%ers given to !e: neither nor any other $erson %ho %as then $resent coached the a""iant regarding the ans%ers given: and any
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"alse attestation shall su')ect !e to disci$linary action, including dis'ar!ent. N TR2T3 4N5 6 TN7++ 637R78#, a! here'y setting !y hand this ______________in Bacolod City, &hili$$ines.

ATTY. _______________ Affiant B& 5 %ith Roll No: ________ B7#8R7 97, on _______, <0=- in Bacolod City, &hili$$ines, a""iant $ersonally a$$eared and sho%ed his a'ove-indicated co!$etent $roo" o" identity. 6itness !y hand and seal.

5oc. No. ______: &age No. ______: Boo; No. ______: +eries o" <0=-.