REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S.S.

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

AFFIDAVIT OF WITNESS

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

resident of _______________________________, after having been duly sworn to in
accordance with law, depose and state:

1. That I was present and personally saw that accused, __________, committed the crime of
_______________________ against the victim __________________;

2. That ___________________________ (State other circumstances and the relation either

to the victim or accused or both);

3. That ___________________________ (State the details of the acts committed by the

accused against the victim);

4. That ___________________________ (State the acts done by the witness and the reason
thereof);

5. That I executed this affidavit to attest the truthfulness of the foregoing facts and to support
the filing of criminal case against ____________________ for violation of
________________________.

IN WITNESS WHEREOF, I hereby affixed my signature

this ___________________ in Makati City, Metro Manila, Philippines.

____________________
Affiant

SUBCRIBED AND SWORN TO before me this ___________________ in

_________________, Philippines, affiant exhibiting to me his/her competent evidence of
identity by way of _________________ issued at ______________
on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.