Judicial Affidavit of ________________ Page 1 of 4

Republic of the Philippines

MUNICIPAL TRIAL COURT IN CITIES
7th Judicial Region
Branch 2
Talisay City, Cebu

PEOPLE OF THE PHILIPPINES,

Plaintiff,

Criminal Case No. 15441

-versus-
FOR: GRAVE COERCION

DIONESIA BACALSO ET. AL.,

Accused.
x----------------------------------------------x

JUDICIAL AFFIDAVIT OF
______________

I, ___________________, of legal age, Filipino, married/single and a

resident of ________________, after having been sworn in accordance with
law hereby depose and state, that:

PRELIMINARY STATEMENT

The person who examined me is Atty. ________ with office address at

_______________________, Philippines. The examination is being held at the
same address. I answered the questions asked of me by Atty.______ fully
conscious that I did so under oath and that I may face criminal liability for false
testimony or perjury. This judicial affidavit is written in English, a language
that is known to me. My examination in question and answer form.

PURPOSE

This JUDICIAL AFFIDAVIT, in lieu of his direct testimony, is being offered

to prove the existence of doubt on the charged of Grave Coercion against the
accused and deny all allegations against her.

Q1: Do you swear to tell the truth and nothing but the truth?
A1: Yes.
 Judicial Affidavit of ________________ Page 2 of 4

Q2: Please state your name, age, residence and occupation?

A2: I am

Q3: Are you the same _______________, who is charge in this case?
A3: Yes.

Q4:
A4:

Q5:
A5:

Q6:
A6:

Q7:
A7:

Q8:
A8:

Q9:
A9:

Q10:
A10:

Q11:
A11:

Q12:
A12:

Q14:
A14:
 Judicial Affidavit of ________________ Page 3 of 4

Q15:

Atty. I have no more questions for you, but during the hearing of this case
Modina: I will ask you to identify documents that are attached to the records
of this case with the court.
Witness: I understand Maam.

IN WITNESS WHEREOF, I hereunto affix my signature this _____ day of

________________ at Cebu City, Philippines.

________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ___________

at Cebu City, Philippines, affiant who is personally known to me, having
avowed to me as to the truthfulness of the contents of herein document
which she voluntarily signed in my presence.

WITNESS MY HAND AND SEAL, on the date and at the place above-
written.

Doc. No._____
Page No. _____
Book No. _____
Series of 2017.

SWORN ATTESTATION

I, ATTY. _________________, Filipino, of legal age, with office address at

Room _____________________ City after having been sworn to in
accordance with law, hereby attest and state: THAT

1. I personally conducted the examination of the accused

_______________.

2. The examination was conducted in English, a language known to the

witness.
 Judicial Affidavit of ________________ Page 4 of 4

3. I have faithfully recorded and/or caused to be recorded the questions

asked and the corresponding answers that the witness gave in the
foregoing Judicial Affidavit, free from any undue influence or
interference; and

4. Neither I nor any other person then present or assisting her coached
the witness regarding the latters answers.

IN WITNESS WHEREOF, I have hereunto set my hands this ____ day of

_____________, at Cebu City, Philippines.

ATTY. ___________________
Affiant

SUBSCRIBED AND SWORN to before me this 26th day of September in Cebu

City, Philippines. Affiant is personally known to me and has avowed before me
under penalty of law to the whole truth of herein document which she
voluntarily signed in my presence.

Doc. No.
Page No.
Book No.
Series of 2017.

Copy Furnished: