Final Exam: Formulating Legal Forms Sample

A.a police officer assigned to take the sworn statement(narrative formand question and answer form)
and affidavit of arrest of a person involved in a case (choose one: murder,rape,robbery)

Sworn Statement
REPUBLIC OF THE PHILIPPINES
REGION 1X Zamboanga del Norte
Municipality of Baliguian

I, JERIC L. UNTANAN, of legal age,Filipino, a resident of Alegria,Baliguian,Zamboaga del Norte, after

being duly sworn in accordance with law, hereby depose and state that:

1. I am full-time employee of Baliguian National High School situated at Brgy. Poblacion, Baliguian,
Zamboanga del Norte working as a security guard in the said School mentioned above, under the
pricipal of this school Mr. Mario Ontanan.

2. On the 2nd of February 2020 at around Teen O'clock in the morning, I was assigned to patrol the
school parking lot.

3. I saw and recognized Alex Blanco in her school uniform together with Shine Blanco as they
approached the parking lot area. At that time, I was about two(2) meters away from the car where Alex
and Shine boarded.

4. Rigth then and there, I saw Shine forcefully made Alex board the 2020 Toyota white and black car,
with plate number ABA 0417, and overhead Alex violently refusing the order of Shine.

5. I did not interview because Shine Blanco is personally known to me, since there were several
instances when she was the one personally tetched her child from school, and Shine used to visit her
husband Carmelito Blanco in the school's Faculty Office.

AFFIDAVIT SAYETH NAUGHT.

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 20th day of May 2020, affiant exhibiting to me his Driver's
Lincense No.N-08-0080000 bearing his photograph and signature, issued on 17 May 2012 at the city of
Zamboanga and valid until 18 May 2020.

Notary Public for Zamboanga

Book No.7

Doc.No. 20

Page No. 7
Series of 2020

Sworn Statement in Question-And-Answer Format

SWORN STATEMENT OF JERIC L. UNTANAN THAT WAS FREELY AND VOLUNTARILY GIVEN TO SPO1,
CARLO CRUZ, MEMBER OF THE PHILIPPINE NATIONAL POLICE, BALIGUIAN STATION 1, INVESTIGATORS
OFFICE LOCATED AT BRGY. POBLACION, BALIGUIAN, ZAMBOANGA DEL NORTE, THIS 1ST DAY OF
OCTOBER, 2020 AT ABOUT 10:30 IN THE MORNING IN THE PRESENCE OF ATTY. CAMILLA YOUNG HIS
CHOSEN COUNSEL OR COUNSEL GIVEN BY THE GOVERNMENT OF THE REBUPLIC OF THE PHILIPPINES, TO
ASSIST HIM IN THE GIVING OF STATEMENTS.

Mr. / JERIC L. UNTANAN

hereby volunteer yourself of a given sworn statement about your personal knowledge about shooting
incident that transpired on October 1, 2020 at 10:30 pm. Before you will give your sworn statements, I
would like to inform you of your rights enshrined under the 1987 Philippine Constitution, as follows:

1. That you have the right to remain silent and any information that you will given can be used as
evidence against you in any court of the Philippines;

2. That you have a right to have a counsel preferable of your own choice, if you cannot afford the
services of the counsel , the Government of the Philippines will give you one to assist you;

3. That you have the right to know why are you here in our Office; and

4. That you have the right to be informed of all your Constitutional rights enumerated above.

QUESTION: After you were informed of all your Constitutional rights, are you willing and voluntarily sign
your signature to attest that you were informed and fully understand your rights under the 1987
Philippine Constitution?

ANSWER: YES SIR,

QUESTION AND ANSWER:

01. QUESTION: Mr. JERIC UNTANAN will you tell the whole truth and only the truth
in this investigation?

ANSWER: Yes, Sir

O2. QUESTION: Are you willing to give your free and willing statement?

ANSWER: Yes

03. QUESTION: Can you in this investigation tell your real name and other identities?

ANSWER: I am JERIC LUMAPAY UNTANAN..,, A.K.A Jer/Jerick

04. QUESTION: What is the reason that you are here in our office and gave your free
and voluntary statement?

ANSWER: I am willing to help in order to stop killing innocent people and justice
for my friend.

05. QUESTION: When and where the incident occured?

ANSWER: Shooting incident transpired at the Cafeteria infront of Baliguian

National High School, at around 10:30 pm.

06. QUESTION: Who were involved the shooting?

ANSWER: Mr. Copido

07. QUESTION: How did the shooting happened?

ANSWER: The person who standing in the dark side of the street immediately
shoot Copido.

08. QUESTION: Do you know the victim?

ANSWER: Yes sir, he is my friendly neighbor.

09. QUESTION: For the benefit of this investigation can you tell what actually
happened in the shooting?

ANSWER: When they are walking along the street there is one person with a
motor already functioning on his side and with mask on his face
standing at the dark side of the street, when they pass through the
person standing in the dark side place immediately shoot my friend
 Carmelo in the back of his head two times resulting the caused of his
death.

10. QUESTION: As you know some of the shooters were armed with guns and what
were the calibers used?

ANSWER: I saw Copido holding his 45 caliber.

11. QUESTION: Besides, do you know other people who had seen such shooting
incident?

ANSWER: No sir, I think I was the one who saw the incident.

12. QUESTION: What did you do after you witnessed the incident?

ANSWER: I pretended that I have not seen the incident because I was scared,
but I was bothered by my conscience.

13. QUESTION: If you see him again can you recognize him?

ANSWER: Yes, sir.

14. QUESTION: For the meantime, I don't have further questions, do you have any
statements to add or take away on this affidavit?

ANSWER: Don't have sir for the meantime.

15. QUESTION: Were you threatened, promised or bribed to do this confession?

ANSWER: No sir, I made it voluntarily with my own free will.

16. QUESTION: Are you willing to sign this affidavit consisting of three (3) pages, to
certify that all the statements you made are true?

ANSWER: Yes, sir.

END OF THE STATEMENT: October 1, 2020 at 11:30 pm

JERIC L. UNATANAN
WITNESS

SUBSCRIBE AND SWORN TO before me this December 1,2020 at police station 1, Brgy.
Poblacion, Baliguian, Zamboanga del Norte.

SPO1. CARLO CRUZ

Administrating Officer

CERTIFICATION

I HEREBY CERTIFY THAT, I have personally examined the herein affiant under oath and that I am
fully satisfied that he voluntarily executed and understood his statement.

SPO1. CARLO CRUZ

Administrating Office

REBUPLIC OF THE PHILIPPINES .)

PROVINCE OF ZAMBOANGA DEL NORTE.) S.S
MUNICIPALITY OF BALIGUIAN...........)

JOIN AFFIDAVIT OF ARREST

We PO1 HAROLD MICABALO, PO1 HAROLD MICABALO, and PO1 RENE OBNEMAGA, legal ages
and presently assigned at Cauayan Police Station Isabela after having been duly sworn to an
accordance with the law, do hereby deposed and state the following:
 1. That on or about 10:30 PM of December 6, 2015 a cellphone call received by personnel of
Baliguian Station from Brgy. Kagawad Aljutor Vertudazo of Poblacion, Baliguian, Zamboanga del
Norte that SPO2 Michael Reyes, 35 years old, married, presently assigned in Baliguian Police
Station and a resident of Brgy. Poblacion, Baliguian,Zamboanga del Norte shot Agapito R. Palma
in his head that caused his instant death with the used of calibre 9mm at the barangay hall of
the said place. Upon receipt of the report, team led by the COP proceeded at the said place and
upon arrival threat, said team together with the said Brgy. Kagawad saw SPO2 Michael Reyes in
the barangay hall and arrested him. Recovered from his direct possession and control is one(1)
9mm Baretta pistol with serial number ABC12345 and one (1) magazine loaded with 12 lives
ammos.

2. That we (PO1 Ryan Micabalo, PO1 Harold Micabalo and PO1 Rene Obnemaga) immediately
arrested the suspect and thereafter informed him of his constitutional rights in language and
dialect known by him in the presence of Barangay Elected Officials .

3. That we brought the suspect to the Police Station for further investigation and proper
disposition; and

4. That we are executing the affidavit/statement to attest the veracity of the aforementioned
facts and to support the filling of appropriate charge/s in Court against the arrested person.

IN THE WITNESS WHEREOF, We hereby affixed our signatures in this 07, December 2015 at
Baliguian, Zamboanga del Norte.

PO1 HAROLD MICABALO PO1 HAROLD MICABALOPO1 RENE OBNEMAGA

Affiant Affiant Affiant
SUBSCRIBE AND SWORN to before me this 7th day of, December 2015 at Baliguian, Zamboanga
del Norte.

MARVIN S. VENEZUELA
Police Senior Inspector
Chief of Police

CERTIFICATION
THIS IS TO CERTIFICATE that I have personally examined the affiant and I am fully satisfied and
convinced that they are voluntarily executed the foregoing affidavit and understood the
contents thereof.

MARVIN S. VENEZUELA
Police Senior Inspector
Chief of Police

B.an offended party involved in a case (choose one: assualt/battery, arson or kidnapping,). Do
the affidavit of complaint and affidavit of desistance.

REPUBLIC OF THE PHILIPPINES

METROPOLITAN TRIAL COURT
NINTH JUDICIAL REGION
 MUNICIPALITY OF BALIGUIAN
BRANCH 8

Jeric Untanan,
Complaint,
-versus- Armando Crus
Criminal Case No. 25386

For: Adultery

Kim Cabigon and Car Luna,

Respondents,

x-------------------x

COMPLAINT- AFFIDAVIT

I, Jeric Untanan, of legal age, a married, and a resident of Brgy. Alegria, Baliguian, after
having been duly sworn to according to law depose and say:

That I am legally married to Kim Cabigon in a religious ceremony before Rev. Gitgamo Ben at
the Parish Church of Baliguian on April 17, 2019, xerox copies of the aforesaid marriage
contracts are hereto attached as Annexes "A" and "B", forming integral parts of this affidavit.

After our marriage, I built a house for our permanent residence and as our conjugal home in
Poblacion, Baliguian and furnished it with all the comforts well within my means;

At the start of our marriage, I was led to believe by my wife of her total concern, love and
devotion to me valid in turn I lavished her with all the material comfort at any command. A
token of my love and unfailing trust, we went sightseeing and on second honeymoon to
America only last month.

Sometimes during the last week of February 2017, while I went on my normal work routine, my
son Jhon took me inside in confidence and told me that he has some very delicate matters to
take up with which may be taken by him in a wrong light; however, he said that his valid dignity
of the family is at mistake and I have to know it what ever be the consequence. After I gave him
the go signal, he narrated that my wife Kim Cabigon has been unfaithful to me having illicit
relationship with another man. He informed that our maid Maria Reyes had been aware of the
relationship and that man usually went to my house and even slept there whenever I saw in
Baliguian. I got angry and so I suggested to think of plan so we can catch wife red-handed.

We agreed to put our plan of action an operation on March 14, 2020 since I will be leaving for
Baliguian in the morning on that day. I thought of removing a glass of the jealousy so the inside
of the bedroom can be seen to the outside. Having completed the plans, I told my wife that I
will be leaving to Cebu on that day. I instructed my son Jhon to inform me immediately of the
result to our plan.

Almost midnight of March 14, 2020, I was informed by my son the operation was successful and
resulted in the arrest of my wife and Car Luna inside our bedroom. Whrn I return to Dipolog
City from Cebu on March 14, 2020, I was shown the photographs taken inside our master
bedroom and I am attaching hereto the photographs which are marked as Annexes "H", "I", "J",
"K", and "L".

That I am formally charging my wife Kim Cabigon and Car Luna of the crime of Aldutery against
them.

CONTRARY TO LAW.

Municipality of Baliguian, Philippines, May 7, 2020.

JERIC UNTANAN
Complainant

SUBSCRIBE AND SWORN to before me, the undersigned prosecutor, this 9th day of May 2020 in
the City of Manila, Philippines. I hereby certify that I have personally examined the above-
named affiant and that I am satisfied that the foregoing statements were given by him
voluntarily and of his own free will.

Atty. Michel Cruz

Assistant City Prosecutor
 Affidavit of Desistance

REBUPLIC OF THE PHILIPPINES .)

CITY OF MANILA.) S.S

I, Jeric Untanan, a legal age, single, and a resident of Baliguian,Zamboanga del Norte after having duly
sworn to in accordance with law hereby despose and state:
 1. I am the complaining for witness for Serious Physical Injuries against Frederick Tojil in the case
entitled "People of the Philippines versus Frederick Tojil", Criminal Case Number 04277, Metropolitan
Trial Court, Branch No. 8, Municipality of Baliguian.

2. After my sober and soul searching assessment and analysis of the incident of the incident, I have
realized that because I was not wearing my eye glasses and it was dark, I cannot point out, without a
doubt an accused or any other person/s who inflicted harm against me.

3. Since I could not state it certainly and without doubt the liab6of Frederick Tojil, in fairness to him, I
am permanently with drawing my complainant against him. I clear him of whatever responsibility or
liability to me.

4. I hereby inform the City Prosecutor of Manila that I am withdrawing my complainant for Serious
Physical Injuries against Frederick Tojil in the case entitled "People of the Philippines versus Frederick
Tojil", Criminal Case Number 04277, Metropolitan Trial Court, Branch No. 8, Municipality of Baliguian.

5. I likewise request the Metropolitan Trial Court, Branch No.8, Municipality of Baliguian to dismiss with
prejudice the said criminal case.

IN WITNESS WHEREOF, I hereby set my hand this 8th day of October 2020 at the Municipality of
Baliguian.

JERIC UNTANAN
Complaining Witness

SUBSCRIBE AND SWORN to before me this 21st day of January 2020at the City of Manila, Philippines.

Tony Abser
Public Prosecutor

c. a witness of crime (choose one: theft, vehicular accident or robbery). Do an affidavit of witness.

REPUBLIC OF THE PHILIPPINES

Province of Zamboanga del Norte
Municipality of Baliguian
AFFIDAVIT OF WITNESS

I, JERIC UNTANAN, 40 years old, married and presently resident at Brgy. Alegria, Baliguian, Zamboanga
del Norte after having be duly sworn to an accordance with the law, do hereby desposes and state:

That on December 1,2020 at about 9:00 in the afternoon while conducted with duty on our Barangay
Hall I saw the victim Rosmar Ebanghelista together with the suspect SPO1 Carlo Mamatol living with the
conversation uttered these words to quote against the former "PAPATAYIN KITA WALANG HIYA KA!".

Thereat I saw the victim shot by the said suspect and sustained 2 guns shot wound at the back of his
head and that caused of his instant death.

That I executed this affidavit/statement to attest the veracity of aforementioned facts and to support
file charge/s in court against the suspect.

AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 1st day of December 2020 at
Poblacion, Baliguian, Zamboanga del Norte.

JERIC UNTANAN
AFFIANT

SUBSCRIBE AND SWORN to before me this 1st day of September 2020 at Baliguian,Zamboanga del
Norte , I HEREBY CERTIFY that I have personally examined the herein affiants and I am satisfied that they
voluntarily executed and understood their given affidavit.

Administering Officer
Notary Public

d. a prosecutor assigned on a________case(choose one: homicide, rape or robbery with homicide). Do

the information form and inquest form.

Republic of the Philippines

National Capital Judicial Region
Regional Trial Court
Branch 127
MUNICIPALITY OF BALIGUIAN
PEOPLE OF THE PHILIPPINES,

Plaintiff,

Crime Case No. 270456

For Homicide

Jeric Untanan -versus-

AKU SANDO, San devil
Accused.

INFORMATION

The undersigned Assistant City Prosecutor hereby accuses Aku Sando of the crime of Homicide
committed as follows:

That on or about April 14, 2020, Baliguian within the jurisdiction of this court, the said accused, armed
with a bladed weapon, with intent to kill, did then and there willfully, unlawfully and felonioualy
attack, assault and stab one VICTIM, thereby inflicting upon him a fatal wound which directly caused
his death. Contrary to law.

Baliguian, Philippines, April 23,2020

ATTY. FACKITUNG
Private Prosecutor

Republic of the Philippines

PHILIPPINE NATIONAL POLICE
Headquarters
Poblacion, Baliguian, Zamboanga del Norte

Date: June 25, 2020

The Honorable Prosecutor
Baliguian

(Attn: Inquest Form)

Sir,

I have the honor to spend you herewith a case of HOMICIDE (DOA) for inquest only, wherein the victim
was one LORINA FEE, 30 years old,single, jobless, and lastly resided at Brgy. Poblacion, Baliguian,
Zamboanga del Norte. The accused is JODEL KYU, 35 years old, single, vendor, native of Baliguian and
residing at Poblacion, Baliguian, Zamboanga del Norte.

(UNDER ARREST)

E. a lawyer assigned on a ________case (choose one: homicide, rape or robbery with homicide). Do the
complaint in criminal case and deposition of witness.