Republic of the Philippines 6th Judicial Region Regional Trial Court Branch __- Bacolod City -o0o________________ Petitioner,

-versus_________________, Respondent. x- - - - - - - - - - - - - - - - - - - x JUDICIAL AFFIDAVIT I am ______________, of legal age, Filipino, single and residing at __________________________. I am one of the witnesses for the Petitioner in this case and I state under oath as follows: PRELIMINARY STATEMENT The person examining me is ATTY. _______________, with office address at __________________________. The examination is being held in the same address. I am answering his questions fully conscious that I do so under oath and that I may face criminal liability for false testimony and perjury. EXAMINATION PROPER 1. Atty. _______: Are you the same __(name of petitioner)__ who filed the Petition entitled _____________ v. ____________ and docketed as Civil Case No. ________ before Branch ___ of the Regional Trial Court in Bacolod City? Witness: Yes, I am the same _______ who filed the said case in court. Case No.:___________

2. Atty. ________: Do you know the Respondent? Witness: Yes, Sir. I first met him/her ______. _______________________________ 3. other essential questions 4. 5. 6. 7. IN TRUTH AND WITNESS WHEREOF, I am hereby setting my hand this ___________in Bacolod City, Philippines.

________________ Affiant I.D. No. ___________ BEFORE ME, on ______________in Bacolod City, Philippines, affiant personally appeared and showed his above-indicated competent proof of identity.

Doc. No. ______; Page No. ______; Book No. ______; Series of 2013. SWORN ATTESTATION OF EXAMINING LAWYER I, ATTY. _______________, the examining lawyer of the affiant in this Judicial Affidavit, after having been duly sworn to in accordance with law, hereby execute this sworn attestation, to wit: I faithfully recorded the questions I asked of the affiant and the corresponding answers given to me; neither I nor any other person who was then present coached the affiant regarding the answers given; and any
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false attestation shall subject me to disciplinary action, including disbarment. IN TRUTH AND WITNESS WHEREOF, I am hereby setting my hand this ______________in Bacolod City, Philippines.

ATTY. _______________ Affiant IBP ID with Roll No: ________ BEFORE ME, on _______, 2013 in Bacolod City, Philippines, affiant personally appeared and showed his above-indicated competent proof of identity. Witness my hand and seal.

Doc. No. ______; Page No. ______; Book No. ______; Series of 2013.