DUMAHIL CRISTINA A. SECTION B.

MWF 6:00-7:00PM CDI 302 BS CRIM 3

Sample Format of Sworn Statement (Question and Answer)

FREE AND VOLUNTARY STATEMENT OF Bueron Shela Mae, a

resident of Brgy. Mansangaban Bais City.GIVEN IN THE
INVESTIGATION OF (Edzilfroy F. Laxina)HERE AT THE OFFICE OF
(Bais City Police station), TODAY (March 12,2024), AT EXACTLY
(8:00AM IN THE MORNING/AFTERNOON/EVENING, IN THE
PRESENCE OF (Rudy Cobol and Emma Jabel)THROUGH
QUESTIONS AND ANSWERS.”
(The person giving the testimony was reminded of all his/her rights in
accordance with what is provided in our New Constitution).
QUESTIONS AND ANSWERS
01. QUESTION- Mister/Miss Bueron Shela Mae will you tell the complete truth and
nothing but the truth in this investigation?"
ANSWER- Yes Sir

02. QUESTION - Are you willing to give your statement freely and voluntarily?"
ANSWER - Yes Sir

03. QUESTION - Can you state for the record your real name and other characteristics
that identify your true person in this investigation?"
ANSWER - Yes Sir. I’m Bueron Shela Mae 30 years old single working as call
center agent , Born in Dumaguete City and Currently Live jn Bais City
Negros Oriental.

04. Q- What is the reason for your presence in our office and for giving your
statement freely and voluntarily?”
A- I am here to state and report about what the suspects do in the victim. I
was setting in the chair Infront of the groceries store owned by Pilmar
Jews, on March 8, 2024 at 5:00 o clock in the evening.

05. Q- When and where did the incident in question occur?”

A - March 8, 2024 at 5 PM in the evening

06. Q - Who is involved in the said incident?”_______________?

A- Paculares Mailyn and April Rose Manlangit

07. Q - How did the incident happened?_________________?

A- I see them arguing and one of the suspects get a knife and stab the victim.

08. Q - Do you know this victims?

A- Yes sir

09. Q- Based on your understanding, can you narrate or describe what really
happened in the said incident?”
A- Here’s what happened I watch them arguing after they argue one of the
suspects get a caliber and shoot the victim in many times resulting to the
death of the victim.
 10. Q - To your knowledge, how many of the individuals had firearms and what
were their calibers?
A - Base of what I see only one of them.

"Page 2. Continuation of the voluntary and spontaneous statement of_Rudy Cobol on this ___
day of March 15 2024.

11. Q - Besides you, do you know of any other individuals who witnessed the said
________________?"
A - The owner of the groceries store

12. Q- What did you do after witnessing the said incident?

A- I called for help to bring the victim into the hospital

13. Q - If you were to see them again and come face to face, would you be able
to recognize them?
A - Yes sir

14. Q - For now, I have no further questions for you. Do you have anything else
you would like to add or modify in your statements
A - No sir

15. Q - Were you threatened, promised anything, or given any rewards for
providing this statement?

A - No sir

16. Q - 16. Q – Are you willing to sign this statement, which consists of (Number of
Pages) pages
A- Yes sir

END OF STATEMENT: MARCH 13 2024

Bueron,Shela Mae
Affiant

SUBSCRIBED AND SWORN TO before me this (March 13, 2024) at (Bais City
Police Station)

PCT.Dumahil,Cristina A.
Administering Officer

CERTIFICATION

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

PCT.Dumahil Cristina A.
Administering Officer