REPUBLIC OF THE PHILIPPINES

)
CITY OF BACOLOD
) S.S.
x-------------------------------------x
AFFIDAVIT OF WITNESS
I, JAN YAP, of legal age, Filipino, single and a resident
of 69 Liwayway St., Bacolod City, after having been duly
sworn to in accordance with law, depose and state:
1. That I am presently employed as an attending physician
at the Riverside Medical Center, Bacolod City;
2. That I was on duty on March 15, 2015 at around 5:30
p.m.;
3. That I personally attended to the medical needs of
Gretchen Puno when she came in for a check up on that
day;
4. That she exhibited signs of hematoma on her frontal and
lateral part of her neck, a peri-orbital hematoma on her left
eye and a 2cm lacerated wound on her upper lip;
5. That I prepared a medical certificate at the request of
Gretchen Puno based on these findings;
6. That I executed this affidavit to attest the truthfulness of
the foregoing facts and to support the filing of criminal case
against Mar Puno for violation of Republic Act 9262.
IN WITNESS WHEREOF, I hereby affixed my signature
this ___________________ in Bacolod City, Negros
Occidental, Philippines.

____________________
Affiant
SUBCRIBED
AND
SWORN
TO before
me
this ___________________ in Bacolod City, Philippines,
affiant exhibiting to me his/her competent evidence of
1

identity by way of _________________

______________ on __________________.

issued

at

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2015.
GABRIELA DAGZ
Notary Public