Republic of the Philippines

Department of Justice
National Prosecution Service
Office of the Provincial Prosecutor
Manolo Fortich Sub-Office,
Old Municipal Building,
Compound, Tankulan

xxx,
Complainant, NPS No. _______________________

- versus - For: THEFT under Article 308 and

ESTAFA under Article 215
xxx, Paragraph 1 (b) of the Revised Penal
Respondent. Code
x--------------------------------------------/

JUDICIAL AFFIDAVIT

The taking of this Judicial Affidavit is being conducted under the

supervision of and the questions propounded by Atty.______________________,
with postal address at_______________________, 18th –1st St., Nazareth, 9000 Cagayan
de Oro City.

The affiant, _______________________ is __ years old, Filipino, married/single,

with postal address___________________________________.

His testimony is offered to show, prove and corroborate the allegations

in the Affidavit-Complaint by _________________________against Mercedita
Balendez for the commission of the following acts punishable under the
Revised Penal Code, to wit; THEFT1 under Article 308 and ESTAFA2 under
Article 315 Paragraph 1(b).

Legend: Q – Question A – Answer

Please state your name, age, address and other personal

1. Q:
circumstances.

A: My name is ________________, __ years old, married/single and a

1
Theft is committed by any person who, with intent to gain but without violence, against, or intimidation of
persons nor force upon things, shall take personal property of another without the latter’s consent.
2
Swindling (estafa). - Any person who shall defraud another by any of the means mentioned hereinbelow
shall be punished by:

I. With unfaithfulness or abuse of confidence, namely:

(a) xxx
(b) By misappropriating or converting, to the prejudice of another, money, goods, or any other
personal property received by the offender in trust or on commission, or for administration, or under
any other obligation involving the duty to make delivery of or to return the same, even though such
obligation be totally or partially guaranteed by a bond; or by denying having received such money,
goods, or other property.
(c) xxx
 resident of (insert residence at Manolo Fortich) a graduate of
(insert scholastic credentials) and currently connected at Kampo
Juan Eco-Adventure Resort owned by the Acosta’s.

2. Q: Why are you here in the office of the xxx?

I am here for the taking of my sworn testimony to prove and

corroborate the allegations in the affidavit-complaint by Dr.
against ___________________ when she reneged on her obligation to
purchase a real property on my behalf and instead swindled and
A:
stole money lawfully belonging to Dr. That I took a video of the
respondent receiving from Dr. a bundle of cash amounting to
P250,000.00 for the purchase of a house and lot for the benefit of
Dr. Acosta’s foundation.

3. Q: Who is____________________________?

She is a contractual employee of_______________________________, the

complainant’s sister, the incumbent District Representative of the 1 st
A: District of Bukidnon. ________________actually works at the House of
Representatives, Quezon City but is presently detailed at Kampo
Juan, Manolo Fortich.

What is the reason, if any, that Mercedita was detailed at Kampo

4. Q: Juan, Manolo Fortich, Bukidnon when she is supposed to be
reporting as a contractual employee of______________?

I am not aware of their kind of working arrangement but she does

A:
report and work at Kampo Juan.

What then is the reason behind the filing of this complaint against
5. Q:
Mercedita, if any?

She took money from ______________ and misappropriated the same

A: by using it for other purposes other than what it was originally
intended.

What proof, if any, can you show that the respondent, _____________
6. Q:
took money from the complainant?

Sometime on December 13, 2020, I took a video of the complainant

A: and the respondent documenting the receipt by ____________ the
amount of P250,000.00 from the ____________.

7. Q: What happened next, if any?

A: I was instructed by ___________ to make a copy of the video clips and

save it in a USB flash disk, hereto included as Annex “__”and made
 an integral part hereof, for purposes of safe keeping and
documentation.

I have with me a USB flash disk, what is this in relation to the one
8. Q:
you previously mentioned?

A: That is the USB flash disk where I saved the video clips.

Showing to you the contents of the USB flash disk, what are these
9. Q:
in relation to the video clip you took on December 13, 2020?

Those are the videos I took on that date showing __________ receiving
A:
money from ____________.

Meantime, I have no more questions to ask. Do you have anything

10. Q:
else you wish to add?

A: None Attorney.

Do you swear that all your answers to the questions asked of you
and the documents attached herewith are true and they proceed
11. Q:
from your own personal knowledge and/or are true and faithful
reproductions of authentic originals?

A: Yes, I do swear.

12. Q: Will sign your Judicial Affidavit?

A: Yes, I will.

_____________________
Affiant

SUBSCRIBED AND SWORN to before me this __ day of December 2021,

at Cagayan de Oro City, Philippines, affiant exhibiting to me his
____________________________as competent proof of her positive identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021.