REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

__ Judicial Region Branch ___
Cebu City

_____
Plaintiff Criminal Case No:

-versus- For:

_____
Defendant

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JUDICIAL AFFIDAVIT OF (SECURITY GUARD WITNESS)

I, (SECURITY GUARD WITNESS), (AGE), (STATUS), residing at (ADDRESS), after having been sworn
to in accordance to the law dispose and state:

That Atty. (NAME OF COUNSEL CONDUCTING THE EXAMINATION) is the counsel who conducted
and supervised my examination at his office at (ADDRESS OF OFFICE)

That I am answering the questions herein fully conscious that I do so under oath and that I may
be criminally liable for false testimony or perjury.

PURPOSE: This affidavit of (SECURITY GUARD WITNESS) is being offered to prove that the accused have
committed a violation of the COMELEC GUN BAN, sometime in the (DATE AND TIME) at (PLACE OF THE
COMMISSION)

Q. 1. Please state your name and other personal circumstances for the record.

A. My name is (NAME OF THE WITNESS), (AGE) years old, (STATUS) and a resident of(ADDRESS). I
am currently a security guard at 711 (ADDRESS OF 711).

Q. 2. Are you the same (NAME OF WITNESS), one of the witnesses in this case?

A. Yes, Sir.

Q: 3. Are you aware and conscious that this in an under Oath, and any falsity of this Judicial-
Affidavit would subject to Prosecution for false testimony or perjury?

A: Yes, Sir.

Q: 4. Where were you on ____ (DATE) at about _____ ( TIME)?

A: I was at 7/11 in Katipunan, Brgy Labangon Cebu City. It was my duty that night.
Q: 5. What are you doing there?

A: It was my shift. I was in duty that time as a security guard in 7/11.

Q: 6. Where there many customers that time?

A: Not really. But there were people coming in and out of the store and police officers outside of
the store.

Q. 7. Do you happen to know (NAME OF THE ACCUSED)?

A. No, Sir.

Q. 8. What do you recall (DATE OF THE ARREST), if any?

A: I was on duty that night. I was doing my routinely task of opening the door for the customers. I
saw the one apprehended outside the store. He was a bit uneasy. A police officer approached
him a few minutes later and after that next thing I knew the officer asked him to face the wall
and then the officer frisked him.

Q. 9. How did the officer conduct it?

A. The officer approached him and introduced himself as a police officer. He later asked him to face
the wall to frisk him. The police officer found the person had a gun. The officer then took the
gun and arrested the person.

Q. 10. Was there any violence conducted during the arrest, if any that you can recall?

A. No, Sir. He as just facing the wall. After the police frisked him and took the gun, the police
recited something then brought him to the police vehicle.

Q: 11. What else did you do, if any?

A: I immediately went back to my shift.

Q: 12. Do you have anything more to say or add in your statement?

A: No more Sir.

We are executing this Judicial Affidavit of the arrest to attest the veracity of the foregoing facts
and circumstances in order to file cases of violation of COMELEC GUN BAN against the named suspect.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ th day of ____ (MONTH
AND YEAR) at Cebu City, Philippines.

NAME OF THE GUARD____________

_________________________
AFFIANT
 SUBSCRIBED AND SWORN to before this ___th day of ____ (MONTH AND DATE) at Cebu, City,
Philippines. I hereby certify that I personally examined the affiant and he fully satisfied that he
voluntarily executed and understood the content of the affidavit.

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PROSECUTION ATTORNEY