REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S.S.

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

AFFIDAVIT OF WITNESS

I, ___________________, of legal age, Filipino,

(single/married/widow) and a resident of
_______________________________, after having been duly sworn to in
accordance with law, depose and state:

1. That I was present and personally saw that accused, __________,

committed the crime of _______________________ against the victim
__________________;

2. That ___________________________ (State other circumstances and

the relation either to the victim or accused or both);

3. That ___________________________ (State the details of the acts

committed by the accused against the victim);

4. That ___________________________ (State the acts done by the

witness and the reason thereof);

5. That I executed this affidavit to attest the truthfulness of the foregoing

facts and to support the filing of criminal case against
____________________ for violation of ________________________.

IN WITNESS WHEREOF, I hereby affixed my signature

this ___________________ in __________________, Philippines.

_________________

Affiant

SUBCRIBED AND SWORN TO before me

this ___________________ in _________________, Philippines, affiant
exhibiting to me his/her competent evidence of identity by way of
_________________ issued at ______________ on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013