SWORN

STATEMENT
OF
___________________
TAKEN
BY
P03
___________________ INSIDE THE INVESTIGATION SECTION OF LA TRINIDAD
POLICE STATION ON DECEMBER 13, 2014. THE STATEMENT WAS TAKEN IN
ILOKANO DIALECT WHICH THE DECLARANT FULLY UNDERSTANDS AND SPEAKS
AND WAS SUBSEQUENTLY TRANSLATED AND ENCODED IN ENGLISH
LANGUAGE BY THE SAME INVESTIGATOR.
Preliminary: Do you swear to tell the truth and nothing but the whole in this
investigation?
Answer:
Yes, sir.
Question 1: Please state your name and other personal circumstances?
Answer:
I am _________________________, 20 years old, single, nursing student,
Filipino, and a resident of ______________________________________.
Q2:
What prompted your presence in this police office at this very moment?
A:
I came here to file my formal complaint against Shi Kumar Yadav, the
driver of Taxi with license Plate Number _______________.
Q3:
Why are you filing a complaint against Mr. Shiv Yadav?
A:
Because he raped me.
Q4:
When and where did the incident happen?
A:
It happened on the night of December 12, 2014 at __________________.
Q5:
How did the incident happen? Could you please narrate?
A:
As a graduating nursing student I am required to render hospital duty. On
December 12, 2014 I was scheduled for duty from ________ to 11:00 in
the evening. Upon discharge of duty or about 11:15 that night I went to the
security guard post near the loading and unloading portion of the highway
and requested the guard on duty to get a taxi for me which the latter
dutifully responded and were able to get one for me, so I boarded the taxi
taking the backseat. I politely told the driver to bring me to
___________________________. Because I was too sleepy I didnt
notice that I fell asleep several minutes after boarding the taxi. I was only
awaken the taxi driver was on my side with his right hand covering my
mouth telling me not to shout, while his left hand was trying to loosen my
belt. Of course, I have to protect myself so I struggled but he is stronger
so I bit his right palm that is still covering my mouth. That caused him to
box me in my abdomen which rendered me unconscious. Taking
advantage of my unconsciousness, culprit successfully fulfilled his
lewdness against me, in other words he successfully raped me.
Q6.
Upon knowing that you were raped, what did you do next?
A:
When I regain consciousness, I was half-naked with my under wear
placed over my private part, while my long pants and my bag were at my
right side about 1 or 2 feet away. I put on my clothes, got my pen light
from my bag and walk down the road, when I reached the main road I
boarded on a jeepney and proceeded to the Police Sub-Station below the
Capitol building at km 6, La Trinidad, Benguet where I was accompanied
to the hospital for medical assistance.
Q7:
Was that the first time you came across with Mr. Yadav?
A:
Yes, sir.
Q8:
I have no more questions to ask, do you want something to add or retract
from your statement?
A:
None at the moment, sir.
Q9:
Are you willing then to sign your statement to prove its veracity and
truthfulness?
A:
Yes, sir.
IN WITNESS, I have hereunto affixed my signature this 13 th day of December,
2014 at La Trinidad, Benguet, Philippines.
___________________
(Declarant)

SUBSCRIBED AND SWORN to before me this 15th day of December, 2014 at La

Trinidad, Benguet, Philippines.

______________________
(Chief of Police)

*Rule 39, Sec. 10(d)