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Sample Format of Sworn Statement (Question and Answer)

Pedro Penduko voluntarily gave a sworn statement to police about a shooting incident he witnessed on December 30, 2019. He stated that he saw Mario shooting a 45 caliber gun at Antonio, his neighbor, three times before running away. Penduko was informed of his constitutional rights before giving his statement. He signed the affidavit to certify that his statements were true and voluntary, and without threat or promise.
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75% found this document useful (16 votes)
23K views3 pages

Sample Format of Sworn Statement (Question and Answer)

Pedro Penduko voluntarily gave a sworn statement to police about a shooting incident he witnessed on December 30, 2019. He stated that he saw Mario shooting a 45 caliber gun at Antonio, his neighbor, three times before running away. Penduko was informed of his constitutional rights before giving his statement. He signed the affidavit to certify that his statements were true and voluntary, and without threat or promise.
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© © All Rights Reserved
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SWORN STATEMENT OF PEDRO PENDUKO THAT

WAS FREELY AND VOLUNTARILY GIVEN TO SPO1, MILVIN SEGUERRA , MEMBER OF THE PHILIPPHINE
NATIONAL POLICE, ORMOC CITY STATION 3 , INVESTIGATORS OFFICE

LOCATED AT BRGY, LILO-AN ORMOC CTY , THIS 31TH DAY OF

DECEMBER, 2019 AT ABOUT 11:30 IN THE MORNING IN THE

PRESENCE OF ATTY, JASPER BARTE HIS CHOSEN

COUNSEL OR COUNSEL GIVEN BY THE GOVERNMENT OF THE REPUBLIC OF

THE PHILIPPINES, TO ASSIST HIM IN THE GIVING OF STATEMENTS

Mr. / PEDRO PENDUKO


hereby volunteer yourself to give sworn statement about your

personal knowledge about shooting incident that

transpired on Dec, 30 2019 at 10:30 pm.. Before you will give

your sworn statements, I would like to inform you of your rights

enshrined under the 1987 Philippine Constitution, as follows:

1. That you have the right to remain silent and any information that

you will give can be used as evidence against you in any court of

the Philippines;

2. That you have a right to have a counsel preferable of your own

choice, if you cannot afford the services of the counsel, the

Government of the Philippines will give you one to assist you;

3. That you have the right to know why you are here in our Office; and

4. That you have the right to be informed of all your Constitutional

rights enumerated above.

QUESTION : After you were informed of all your Constitutional rights,

are you willing and voluntarily sign your signature to

attest that you were informed and fully understand your

rights under the 1987 Philippine Constitution?

ANSWER: YES SIR,

QUESTION AND ANSWER:


01. QUESTION [Link] PENDUKO will you tell the whole truth and only the truth in
- this investigation?
ANSWER YES,SIR
-

02. QUESTION Are you willing to give your free And willing statemen?
-
ANSWER - YES

03. QUESTION Can this investagation tell you your real name and other identities of
- your true identity?
ANSWER I AM PEDRO M, PENDUKO ,, A.K.A PETER
-

04. QUESTION What is the reason and you are here in our office and gave your free
- and voluntary statement?
ANSWER - I am willing to help in order to stop killing innocent people

05. QUESTION Where and when such an incident occurred?


-
ANSWER- in brgy, san antonio ormoc city, at around 10:30 pm

06. QUESTION Who where involve in the shooting?


-
ANSWER - Mr. MARIO

07. QUESTION How the shooting happened?


-
ANSWER - I think there is an old grudges between them sir .

08. QUESTION Do you know the victim?


-
ASWER - yes sir , he is my friendly neighbor

09. QUESTION - For the clear of this investigation you can tell or tell what acually
happened in the shooting?
ANSWER - When i was going to buy some softdrinks in the near of the incident , i
saw MARIO was holding a gun and i was scared i was able to hide
and later on ANTONIO (the victim) is walking he shoot 3 times and
run away .

10. QUESTION As you know some of the shooters were armed with guns and what
- were thier caliber?
ANSWER - i saw MARIO holding his 45 caliber

Page 2 of the free and voluntary statement of PEDRO PENDUKO, this time 31 of
DECEMBER , 2019.
11. QUESTION Besides you do you know people who have seen such shoot_?
-
ANSWER- no sir, i think i am the one who saw the incident

12. QUESTION What did you do after you witnessed the incident?
-
ANSWER - I pretending that i have not seen the incident [Link] scared but i was
failed with my consience

13. QUESTION If you see him again can you recognize him?
-
ANSWER - yes sir

14. QUESTION For the meantime, I don’t have further questions, do you have any
- statements to add or take away on this affidavit?

ANSWER- Don't have sir for the meantime.

15. QUESTION Were you threatened, promised or bribed to do this confession?


-
ANSWER - No sir. I made it voluntarily with my own free will.

16. QUESTION- Are you willing to sign this affidavit consisting of three (3) pages, to
certify that all the statements you made are true.

ANSWER - Yes, sir

END OF THE STATEMENT: december 31, 2019 1:00pm


PEDRO PENDUKO
WITNESS

SUBSCRIBED AND SWORN TO before me this December, 31 2019 at police station


3,brgy liloan ormoc city

SPO1, MILVIN SUEGUERRA


Administering Officer

CERTIFICATION

I HEREBY CERTIFY THAT I have personally examined the herein affiant under oath and
that I am fully satisfied that he/she voluntarily executed and understood her statement.

SPO1, MILVIN SUEGUERRA


Administering Officer

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