REPUBLIC OF THE PHILIPPINES

)
CITY OF BACOLOD
) S.S.
x-------------------------------------x
AFFIDAVIT OF WITNESS
I, EL SUPLADO SEGUMPAN, of legal age, Filipino,
single and a resident of 321 Burgos St., Bacolod City, after
having been duly sworn to in accordance with law, depose
and state:
1. That I am presently employed as a Senior Police Officer 2
at the Villamonte Police Station, Bacolod City, Negros
Occidental;
2. That I was on duty on March 15, 2015 at around 10:00
p.m.;
3. That I personally received the complaint of Gretchen Puno
to file a police blotter on that day;
4. That she complained of her husband beating her up and
strangling her outside their home;
5. That I prepared the police blotter report of Gretchen
Puno;
6. That I executed this affidavit to attest the truthfulness of
the foregoing facts and to support the filing of criminal case
against Mar Puno for violation of Republic Act 9262.
IN WITNESS WHEREOF, I hereby affixed my signature
this ___________________ in Bacolod City, Negros
Occidental, Philippines.

_____________
Affiant
SUBCRIBED
AND
SWORN
TO before
me
this ___________________ in Bacolod City, Philippines,
affiant exhibiting to me his/her competent evidence of
1

identity by way of _________________

______________ on __________________.

issued

at

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2015.
GABRIELA DAGZ
Notary Public