REPUBLIC OF THE PHILIPPINES

First Judicial Region

Regional Trial Court
Branch

___________________
Plaintiff,
Civil Case No. ___

-versus- For:

_________________. DECLARATION OF
Defendant, NULLITY OF
MARRIAGE
x - - - - - - - - - - - - - - - - -- - - - - - - x

JUDICIAL AFFIDAVIT

I, _____________, of legal age, married, Filipino Citizen

and with office address at Department of Psychiatry,
__________City, after having been duly sworn to in accordance
with law, hereby depose and state that:

I am the psychiatrist engaged by the plaintiff in this case to

conduct the Psychiatric Study and evaluation of the parties;

In relation to the above-entitled case, the counsel Atty.

_____________ at his office located at __________________asked me
questions which questions I answered while I was in my clinic, fully
conscious that I did so under oath and that I may face perjury and any
other criminal liability for false testimony;

The questions asked by Atty. _____________ and the

answers I gave are as follows, to wit:

1. QUESTION (Q): Madam Witness, do you know the

plaintiff in this case?
ANSWER (A): Yes sir.

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2. Q: Why do you know her?
A: She came to my clinic sometime in May 2011 to request
for a psychiatric evaluation on her person and that of her
spouse in relation to a case of Declaration of Nullity of Marriage
that she had filed.

3. Q: Did you conduct a psychiatric study of the parties in this

case?
A: Yes sir.

4. Q: Now, could you please tell us the manner by which you

conducted your study?
A: I did the standard procedure which was to do a detailed
psychiatric history and mental status examination by
psychiatric interviews with the petitioner. I also subjected the
petitioner to a battery of psychological tests. Collateral
informants were interviewed. The information gathered was
then studied and collated to make a written report.

5. Q: Who were the persons you interviewed?

A: I interviewed Ms. Helen Teodoro, older sister of the
petitioner Sir.

6. Q: Were you able to interview the Defendant?

A: No Sir.

7. Q: Madam witness, in connection with your study, what were

your findings insofar as the plaintiff is concerned?
A: I assess the petitioner to be suffering from a personality
disorder classified as a Dependent Personality Disorder Sir

8. Q: In terms that could be understood even by a layman, could

you please elaborate on the disorder of the plaintiff?
1. A: This is a pervasive and excessive need to be taken care of that
leads to submissive and clinging behaviours such as the following:
needs others to assume responsibility for most major areas of her
life, has difficulty expressing disagreement with others because of
fear of loss of support and approval, and feels uncomfortable
when alone because of fear of being unable to take care of herself.

9. Q: This kind of disorder on the part of the plaintiff, is this

chronic?
A: yes sir.

10. Q: is it pathological?
A: yes sir.

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11. Q: Does it boarder on a kind of neurosis or psychosis?
A: It is a neurotic disorder.

12.Q: Now madam witness, you are trying to tell us that this
Dependent personality disorder is pathological and chronic. Did
it gravely affect the marriage of the plaintiff?
A: yes sir.

13. Q: Why do you say so?

A: It had adversely affected the marriage because the disorder
rendered the petitioner

14.Q: Madam witness, with regard to the disorder of the Plaintiff,

did this disorder exist even before she entered into her marriage
with the Respondent?
A: yes sir.

15. Q: Is the disorder on the part of the Plaintiff clinically proven by

your findings?
A: yes sir.

16.Q: Is the same disorder grave and incurable?

A: yes sir.

17. Q: How about the Defendant. Did you infer any findings as to
his personality?
A: yes sir.

18. Q: And what is your inference with regards to the

personality of the Defendant?
A: I inferred that the respondent suffers from a Narcissistic
Personality Disorder.

19.Q: In terms that could be understood even by a layman, could

you please elaborate on the disorder of the Defendant?
A: This is characterized by a pervasive pattern of grandiosity, need
for admiration and lack of empathy as indicated by the following: he
has as a grandiose sense of self importance, he has a sense of
entitlement , he is interpersonally exploitative where he takes
advantage of others to achieve his own ends, he lacks empathy where
he is unwilling to recognize or identify with the feelings of his wife
and he showed arrogant behaviors.

20. Q: This kind of disorder on the part of the Defendant, is

this chronic?
A: yes sir.

21.Q: is it pathological?

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 A: yes sir.

22. Q: Does it border on a kind of neurosis or psychosis?

A: yes sir.

23. With regard to the disorder of the Defendant, did this

disorder exist even before he entered into his marriage with the
Plaintiff?
A: yes sir.

24. Q: Do you consider the same disorder grave and

incurable?
A: yes sir.

25. Q: What then do you recommend as far as the marriage of

the parties herein is concerned?
A: Considering that the spouses both suffer from
personality disorders that are responsible for their inability to
fulfill their marital obligations, I respectfully recommend to the
Honorable Court that the petition for Declaration of Nullity of
Marriage between the parties be granted, sir.

26. Q: madam witness, did you put your findings in writing?

A: yes sir.

27. Q: if the said written report you mentioned will be shown

to you, will you be able to identify it?
A: yes sir.

28. Q: I have here a document which purports to be a

psychiatric evaluation report, dated October 18, 2012, can you
please kindly go over it and tell this Honorable court its relation to
the document you are referring to.
A: Sir, this is the same psychiatric evaluation report that I have
made.

29. Q: Found on the last page of the same document is a

signature above the typewritten name Dr. Clarette Rosario P.
Dy, MD, whose signature is that?
A: It is my signature, sir.

30. Q: I have no further questions. Do you have anything to

add or retract, Madam Witness?
A: No sir.

31.Q: Are you willing to sign your statement?

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 A: Yes sir.

Affiant
PRC ID No. _____
Issued on ,August 4, 1992
At PRC, Manila

SUBSCRIBED AND SWORN to before me, this ___ day of 2014,

in the City of _______, Philippines, affiant exhibiting to me her
proof of identification as indicated below her typewritten name.

Doc. No. ______ ;

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

ATTESTATION

I hereby state, under oath, that I faithfully recorded the questions

I asked and the corresponding answers that the witness gave and that
neither I nor any other person present or assisting me has coached the
witness regarding the latter’s statement.

ATTY. ___________________

SUBSCRIBED AND SWORN to before me, this ___ day of 2014,

in the City of Baguio, Philippines, affiant exhibiting to me her proof of
identification as indicated below her typewritten name.

Doc. No. ______ ;

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

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