REPUBLIC OF THE PHILIPPINES )

PASAY CITY, METRO MANILA ) S.S

X________________________________x

AFFIDAVIT OF WITNESS

I, _____________________, married, of legal age, Filipino, having been sworn to in

accordance with law, hereby depose and state that:

1. I am the incumbent Barangay Captain at Brgy. 44, Pasay City.

2. After the COVID – 19 Pandemic breakout, we have been tasked by the Department
of Interior and Local Government to assist in the monitoring and supervising of
residents in our respective jurisdictions who are reported to be or is suspected to
have been infected with the virus.

3. On September 17, 2020, it has been brought to our knowledge that a resident
naming ________________ had undergone an RT – PCR test for COVID – 19.

4. Upon knowing of _________________’s condition, and based on existing protocols, I

immediately sent two (2) Barangay Health Workers to the former’s residence for
monitoring at around 4:00 in the afternoon.

5. A couple of hours later, or at around 5:30 in the afternoon, the Barangay Health
Workers I sent came back and submitted a report regarding ____________’s
condition, attesting that they have personally checked his body temperature and all
other circumstances needed to file a COVID – 19 suspected patient’s form.

6. Our barangay has a program in combating the COVID – 19 pandemic wherein the
Barangay provides for a care package, which includes food, for the patient, whether
confirmed to have the virus or suspected to have it, in order to ensure that they stay
at home and follow the strict quarantine protocols. And since _____________ is
already in the list of our suspected patient – resident, I, together with two (2) other
barangay employees, went to his residence to give the said care package.

7. At around 8:00 in the evening, we arrived at _______________’s house where he

personally received the care package from our Barangay.
 8. I am executing this affidavit to attest to the truth of the foregoing circumstances.

AFFIANT SAYETH NAUGHT

IN WITNESS WHEREOF, I hereunto affixed my signature this 24th day of September, 2020
at Pasay City, Metro Manila

_____________________________
Affiant

SUBSCRIBED AND SWORN to before me this 24th day of September 2020, affiant
exhibiting to me his Voter’s ID no. __________________ issued in ________________ on
________________

NOTARY PUBLIC