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REPUBLIC OF THE PHILIPPINES

NATIONAL CAPITAL JUDICIAL REGION


REGIONAL TRIAL COURT
MAKATI CITY
BRANCH

HERMINIA VICE
Plaintiff,

- versus - Civil Case No. 12-345

VHONG GONG,
Accused.

x-----------------------------------------------------------------------------------------x

JUDICIAL AFFIDAVIT

Ako, si HERMINIA VICE nasa hustong gulang, Filipino,


kasalukuyang naninirahan sa________________--, matapos
manumpa ng naayon sa batas ay malaya at kusang loob na
nagsasaad ng mga sumusunod sa pamamagitan ng pagsagot sa
mga tanong ni ________________na isinagawa sa kanilang opisina,
matatagpuan sa _________________-

ABOGADO: The testimony of the witness is hereby being


offered:

ABOGADO : With the permission of the Honorable Court.

Q:
A:

ABOGADO: No more further questions for the witness.


BILANG PATUNAY, ako ay lumagda sa ibabaw ng aking
pangalan ngayon ika-______ ng Nobyembre 2014.

HERMINIA VICE

SINUMPAAN AT PINATOTOHANAN sa harap ko ngayon ika


__________ ng Nobyembre 2014. Pinatutunayan ko na ang
nagsalaysay ay aking nasiyasat at ako ay may sapat na paniniwala
na siya ay kusa at malayang nagsalaysay.

NOTARY PUBLIC

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2014

ATTESTATION
I, ABOGADO, of legal age, Filipino, after having been duly
sworn to in accordance with law hereby depose and state:

1. I am the one collaborating counsels for the Plaintiff Herminia,


in the above-captioned case.

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2. I personally conducted the foregoing Judicial Affidavit of the
Plaintiff, Herminia in our law firms office at ___-
3. I hereby certify that I faithfully recorded the questions I asked
and the answer of the witness.

4. I likewise certify that neither I nor any person then present


had coached the witness regarding her answers to the
questions propounded.

IN WITNESS WHEREOF, I have hereunto affixed my signature


this ____ day of November 2014, in Makati City.

ARJEL P. DE GUZMAN

SUBSCRIBED AND SWORN to before me on the date and


place above written, affiant exhibiting his IBP identification card as
proof of identity.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2014.