Republic of the Philippines

REGIONAL TRIAL COURT

Quezon City
Branch

PEOPLE OF THE PHILIPPINES, CRIM. CASE NO.

Plaintiff,
For:
-versus- QUALIFIED THEFT

___________________________
Accused.

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JUDICIAL AFFIDAVIT
OF _________________________

I, _________________, of legal age, single, with residence address

at__________________, hereby answer, having been duly sworn to in accordance with
law, hereby deposes and states.

I. PRELIMINARY STATEMENT

That the taking of my judicial affidavit was administered and supervised

by__________________and was done in his law office at___________, and I am
fully aware and cognizant of the questions asked of me and my answers are under
oath being aware that I may face criminal liability for false testimony or perjury.

OFFER OF TESTIMONY