Republic of the Philippines)

Province of Bukidnon ) S.S. FOR EDUCATIONAL PURPOSES ONLY

Municipality of ______ )

JUDICIAL AFFIDAVIT OF WITNESS

I, _____________________, 55 YEARS OLD, MARRIED, BORN ON

FEBRUARY 25, 1965 AND A RESIDENT OF P-5
_____________________, BUKIDNON AFTER HAVING BEEN DULY
SWORN TO IN ACCORDANCE WITH THE LAW DO HEREBY DEPOSE
AND STATE:

PRELIMINARY STATEMENT

The person examining me is PCPL _____________________of

________ Municipal Police Station, ________, Bukidnon who conducted
and supervised my examination as witness at this office at ________
Municipal Police Station, __________, Bukidnon.

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: PURPOSE: That Affiant/Testimony of the witness

_____________________ is being offered to prove that the
respondent/suspect _____________________ y ______ was actually
violated the case of Reckless Imprudence Resulting to Multiple
Homicide.

Question No. 1 (Q1): Palihog isulti and imong pangalan ug uban

pang timailhan sa imong pagkatawo?

:( Please state your name and other personal identities?)

Answer No. 1 (A1): Ako si _____________________, 39 anyos,

menyo, natawo kaniadtong Agosto 06, 1982 og nagpuyo sa P-5 Brgy
_____________________, Bukidnon.

: (I, _____________________, 39 years old, married, born on August

06, 1982, and a resident of P-5 _____________________, Bukidnon.)

Q2: Nganong ania ka man dinhi sa buhatan sa kapulisan sa

________, ________, Bukidnon?

:( Why are you here in the Police Station of ________,

________, Bukidnon?)
 A2: Aron sa paghatag sa akong bulontaryo nga testimonya kabahin
sa nahitabo nga Reckless Imprudence Resulting to Multiple Homicide.

:( To offer my voluntary statement about the Reckless

Imprudence Resulting to Multiple Homicide.)

Q3: Asa man diay ka ato sa dihang nahitabo ang pagpamangga?

:( Where were you when bumping incident was happened?)

A3: Paingon ko sa sentro sa ____________, Bukidnon sakay sakong

motorsiklo og nag sunod sa motorsiklo nga Yamaha MIO 125 nga
nabanggaan sa Isuzu Elf.

:(I was going to ___________, Bukidnon proper onboard on my

motorcycle and I was the tailing vehicle of Yamaha MIO 125 who was
bumped by Isuzu Elf.)

Q4: Mahimo ba nimong isaysay ang mga panghitabo kaniadtong

October 13, 2021 sa may alas 10:55 sa buntag kapin og kulang?

:( Can you please narrate the incident that was happened on

October 13,2021 at more or less 10:55 AM in the morning?)

A4: Neadtung October 13, 2021 banda alas 10:30 AM sa buntag

kapin og kulang paengun ako sa sentro sa ___________, Bukidnon gekan
sa among balai sa P-5 Brgy ________,, Bukidnon mga banda alas 10:55
sa buntag kapin og kulang naavot ako sa P-4 ________, Bukidnon nga
sunod sa Yamaha Motorcycle 125 a og mao akong nakita nga ang Isuzu
Elf/Dent Dropside nga didto na miagi sah pikas dalan og ne counterflow
sah agi-anan sa yamaha Mio Motorcycle kun diin asa nag agi ang maong
motorsiklo og eya kining gibangga

:( On October 13,2021 at about 10:30 o’clock in the morning

more or less I was going to ____________, Bukidnon proper coming
from my house at P-5 Brgy. ________,, Bukidnon at 10:55AM in the
morning I was arrived at P-4 ______________________, Bukidnon and I
am the tailing vehicle of Yamaha motorcycle 125 and I saw that Isuzu
Elf/Dent Dropside was travelling to opposite lane direction and
counterflow to opposite lane direction wherein the Yamaha motorcycle
was travelling and bumped/hit the said motorcycle.

Q5: Geunsa man nemu pag ila ang maong driver sa Isuzu Elf/Dent
dropside kai mao si __________________ y _______?

: (How do you know the driver of Isuzu Elf/Dent dropsideo is

__________________ y _______?)
 A5: Pag ka kita nko niya sa __________ Police Station kai siya
boluntaryo nga me surinder positibo nako siya nga nailhan tungod kai
mahenumdoman pa nko eyang dagway,ang eyang pamarog og kong unsa
ang iyang gesout nga senina sa maong insedente mao usab eyang gesout
pag surinder niya sa __________ Police Station og ako siya nga naila nga
mao deay se __________________ y _______.

: (I saw him at ________ Police Station who voluntarily

surrendered and I positively identify him because I remember his face, his
pose and of what he was wearing at the incident the same clothes he was
wearing when he surrendered at _________ Police Station and I know him
that he is __________________ y _______)

Q6: Niining taknaa ang imbestigador wala nay ika-pangutana pa diha

kanimo, aduna ka ba’y ika-dugang o buot usabon sa imong mga
gipamulong sa unahan?

: (For the meantime this investigator has nothing more to ask,

do you have something more to say, add or retract from your
statement?)

A6. Wala na sa pagkakaron sir.

:( None, for the meantime sir.)

Q7. Nasayod ka ba nga kining imong affidavit imong panumpaan,

nagpasabot kana nga kung mapamatud-an nga namakak ka sa imong
pagtubag sa mga pangutana sa unahan, mahimo ka kasohan ug Perjury or
False Testimony?

:( Q: Are you aware that this affidavit is under oath which

means that you may be prosecuted for Perjury or False Testimony if
it turns out that you lied about any of the answers you have given in
response to the questions propounded to you?)

A7. Oo, nasayod ako.

:( Yes, I know.)

Q8. Bulontaryo ba kini nimong pagpirma sa imong affidavit, walay

nagpugos, naghadlok of nagsaad nimo ug gasa o sa bisan unsa?

:( Are you willing to sign this affidavit of yours without being forced,
coerced, intimidated nor promised of any prize, reward or whatsoever?)

A8. Oo.
:( Yes).
 IN WITNESS WHEREOF, I hereby voluntarily affixed hereunto my
signature this 14th day of October 2021 at __________ Municipal Police
Station, __________, Bukidnon, Philippines.

___________________
Affiant

Subscribed and sworn to before me this____day of October 2021 at

Malaybalay City, Bukidnon, Philippines. I further certify that I have
personally examined the above named affiant and that I am satisfied that
he voluntarily executed and understood his affidavit.

ATTESTATION

I HEREBY CERTIFY that I personally conducted and I have caused

to be recorded the questions propounded to him as well as the
corresponding answers given thereto and such answers were given freely
and voluntarily by said affiant without being coached by the undersigned or
any person then present.

October 13th 2021, ________ Municipal Police Station, __________,

Bukidnon, Philippines

PCPL __________________
Investigator

SUBSCRIBED AND SWORN to before me this ___day of October

2021 at Malaybalay City, Bukidnon, Philippine. I HEREBY CERTIFY further
that I personally examined the above named affiant and this foregoing
affidavit and I am convinced that he voluntary executed the same and fully
understood the contents therein.