Republic of the Philippines )

Province of Leyte
) s.s.
Municipality of Hilongos
)
x- - - - - - - - - - - - - - - - - - - - - -x
AFFIDAVIT OF WITNESS
I, _____________________________, ______,________________, resident of
____________________________, ____________, after having sworn in accordance with law,
do hereby depose and state THAT:
I was present and personally saw that accused, ________________, ______,
________________, a resident of _________________________ , committed the crime of
___________________________________________________ ;
Upon the conduct of the LEYECO IV Apprehension Team the accused was caught in
flagrante delicto of the said violation.
The LEYECO IV Apprehension Team explained the accused of his/her rights vested in
our constitution and the latter explained that he/she can settle of his/her offense in their office as
soon as possible before the information will be filed in the proper court.
The
following
were
found
in
the
scene;
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________ . It was properly handled by the apprehension team and the
apprehension was documented not to prejudice the accused for planting evidence against
him/her.

I executed this affidavit to attest the truthfulness of the foregoing facts and to support the
filing of Criminal Cases against _______________________________ for violations of
________________________.
AFFIANTS SAYETH NAUGHT.
IN WITNESS WHEREOF, I hereunto affixed my signature this ___day of ____________
at ___________________, ______________________.

_______________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of _______ at

_______________. I HEREBY CERTIFY that I have personally examined the herein affiants
and I am satisfied that they voluntarily executed and understood their given affidavit.

___________________________
Notary Public