Republic of the Philippines )

City of _______________ ) S.S.

AFFIDAVIT OF WITNESS

I, _______________ (name), __________ (age), ___________ (civil status), resident of

__________________________________________, after having sworn in accordance with law, do
hereby depose and say that:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10. I executed this affidavit to attest the truthfulness of the foregoing facts and to support the filing

of the administrative case against _______________ and for any legal purpose it may best

serve.

IN WITNESS WHEREOF, I hereunto affix my signature this _____ day of _____ 20__ at city of
______, Philippines.

__________________________
Affiant

SUBSCRIBE AND SWORN to before me this _____ day of _____ 20____ at __________, affiant
exhibiting to me his/her _____________ as competent proof of identity issued at _________.

NOTARY PUBLIC

Doc No: _______

Page No: _______
Book No: _______
Series of _______