Republic of the Philippines

REGIONAL TRIAL COURT

FIRST JUDICIAL REGION
BRANCH 123
San Carlos City, Pangasinan

IN RE: IN THE MATTER OF THE ADOPTION

OF MINOR ABCE GALSIM

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SPEC. PROC. CASE NO. SCC-123-45-2022

SPS. MARK LESTER T. BASA and

MARILANE G. BASA,
Petitioners.
x-----------------------------------------x

Republic of the Philippines )

City of San Carlos, Pang ) S.S.

JUDICIAL AFFIDAVIT OF
MARK LESTER T. BASA

Preliminaries

1. That this judicial affidavit being executed by the witness shall form part of his direct
testimony;
2. Which the taking testimony was supervised and conducted in the presence of Atty Eisley
Sarzadilla-Garcia at her office at San Carlos City, Pangasinan.
3. That the witness was fully conscious and is fully aware that he may face criminal liability
for any false testimony;

Atty.Eisley Sarzadilla-Garcia : We are offering the testimony of this witness to prove the
following:

1. He is one of the petitioners in this case;

2. He is the husband of his co-petitioner, the biological mother of the child sought to be
adopted;
3. He possesses all the qualification and none of the disqualification provided by law to
adopt;
4. And to prove other material allegation in the Petition.
Atty Eisley. Q: Do you swear to tell the truth and nothing but the truth in this proceeding?

1. Q: Please state your name and other personal circumstance:

A: I am MARK LESTER T. BASA, of legal age, Filipino, married, and a resident of Brgy.
Tarece, San Carlos City, Pangasinan after having been duly sworn in accordance with
law, do hereby despose state that I am executing this Judicial Affidavit in question and
answer form conducted and the same shall serve as part of my direct testimony in the
above entitled case.

2. Q: Who are the petitioners in this case, mister witness?

A: Me and my wife Marilane basa are the petitioners, ma’am.

3. Q: Do you have proof to show that you are married to you co-petitoner?
A: Yes, I have a copy of our marriage certificate, ma’am

4. Q:showing to you the copy of said Certificate of Marriage of Mark Lester T. Basa and
Marilane Basa, what is the relation of this to the one you are referring to?
A: this is the one, ma’am

Atty. : may we pray the marking in the Certificate of Marriage of Mark Lester T. Basa and
Marilane Basa married on December, 2018 in San Carlos City, Pangasinan as Exhibit “A” for the
the petitioner be maintained.

5. Q: In this Pertition, you said that you and your wife desire to adopt a minor, who is that
child?
A: he is ABCDE Galsim, ma’am

6. Q: how is he related to your co-petitioner?

A: ABCDE is the son of my wife, ma’am

7. Q: how old is he at present, if you know?

A: he is seven (7) years old at present ma’am

8. Q:What is your proof that he is the son of Marilane?

A: I have a copy of his birth certificate issued by PSA, ma’am.

9. Q: showing to you the copy of the birth certificate of ABCDE GALSIM born April 20,
2014, is this the one you are referring to?
A: yes ma’am

Atty. Eisley: May we pray that the marking on the birth certificate of ABCDE GALSIM born April
20, 2014 in San Carlos City, Pangasinan as Exhibit “B” for the peritioners be maintained.

10. Q: Whos is the father of ABCDE, if you know?

 A: His biological father is the former boyfriend of Marilane his name is Mario Galsim,
ma’am.

11. Q: where is his biological father, if you know?

A: I do not know but I think he is with his wife and child red, ma’am.

12. Q: why did you decide to adopt the child of your wife:
A: I have loved him like my own son and we wanted to give him a better future ma’am.

13. In the process of this case, what processes did you undergo, if there be any?
A: We went to our lawyer and she told me to prepare the documents and we are also
interviewed by the social worker ma’am.

14. Q: What is your source of income?

A: I am currently employed and have several businesses with my wife ma’am.

15. Q: Do you have any proof of your business and employment?

A: I have my certificate of employment and permit to operate ma’am

Atty. Eisley: May we pray that the certificate of employment and permit to operate be marked
as Exhibit “C” and Exhibit “D” for the petioners.

16. Q: So who is/are supporting the needs of ABCDE?

A: we are both supporting the needs of our son, ma’am.

17. Q: what other proof do you have to show that you are financially capable to support the
needs of your son?
A: We have savings, in the bank, ma’am.

Atty. Eisley: may we pray that the BDO savings account of spouses be marked as Exhibit “E” for
the petitioners;

18. Q: Mister witness, are you physically and medically fit?

A: yes ma’am.

19. Q: What is your proof that you are physically fit?

A: I have undergone medical examination and was issued a medical certificate ma’am.

Atty. Eisley: may we pray that the medical certificate of the petioner be marked as Exhibit “F”
for the petioners.

20. Q: have you been convicted/charged of any offense?

A: no, ma’am
 21. Q: what is your proof that you have not been convicted/charged of any offense?
A: my police and NBI clearance ma’am.

Atty. Eisley: may we pray that the Police Clearance and NBI clearance of the petitioner be
marked Exhibit “G” and “H”.

22. Q: Do you and your wife have any children?

A: No, ma’am.

23. Q: can you described your relationship with ABCDE?

A: I consider him like my son, I give him the love and care he deserves. We have learned
to be very close to each other, ma’am.

24. Q: do you have pictures to show your relationship with the child?
A: yes, ma’am

Atty. Eisley: may we pray that the pcitures be marked as Exhibit “I” for the petitoners.

25. Q: Do you know the legal effects of this petition, if granted by the Honorable Court?
A: Yes, ma’am.

26. Q: would you still want to adopt ABCDE despite such legal effect?
A: Yes, ma’am.

IN WITNESS WHEREOF, I have hereunto set my hands this 18 th day of April 2022 at San
Carlos City, Pangasinan.

MARK LESTER T. BASA

Affiant
I.D NO. A05-17-00123
Valid until 2023-11-20

SUBSCRIBED AND SWORN to before me on the date and at the place first above
mentioned, affiant exhibiting to me his competent proof of identity, already appearing below
his name and signature.

Doc No._______
Page No.______
Book VIII
Series of 2022
 ATTESTATION

I, Atty. Eisley Sarzadilla-Garcia with office address at San Carlos City, Pangasinan hereby
certify that I have personally conducted the examination of the witness; that I have faithfully
caused to be recorded the corresponding questions I have asked to the witness and that the
answers of said withness were likewise faithfully recorded and caused to be recorded; That no
other person was then present or assisting or coached the witness in answering the questions
asked to him.

Atty. Eisley Sarzadilla-Garcia

Roll of Attorneys No. 1234567