Republic of the Philippines

National Capital Judicial Region

REGIONAL TRIAL COURT
Caloocan City
Branch ___

__________________,
Petitioner,

-versus- CIVIL CASE No.

__________
For: Nullity of Marriage

__________________,
Respondent.
x ------------------------------- x

JUDICIAL AFFIDAVIT

PRELIMINARY STATEMENT

I, _______________, Filipino, of legal age, with address at

_______________________, after having been sworn in
accordance with law, hereby execute this Judicial Affidavit, in
Question and Answer form, and hereby answer the following
questions below in answer to the claims and allegations of Petitioner
__________________, in Civil Case No. __________ for Nullity
of Marriage pending before _______________. Consciously
knowing that I am under oath, and with understanding that I may
face criminal liability for false testimony or perjury, I hereby answer
the following questions from ATTY. EARLEEN H. DEL ROSARIO
with office address at 18 Plaza Rizal, Poblacion, Caloocan City, who
conducted this examination in her office.

OFFER OF TESTIMONY

The following testimony of affiant ___________ is being

offered to prove the following:

a. That Respondent do not have psychological incapacity;

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JUDICIAL AFFIDAVIT PROPER

1. Q: Do you swear to tell the truth and nothing but the truth?

A: Yes, I do.

2. Q: Are you aware that you may face criminal liability for false
testimony of perjury if you will not tell the truth?

A: Yes, I am.

3. Q: Please state your name, age and other personal

circumstances.

A: I am _________, of legal age, married, and with address

at ______________.

4. Q: Where are you currently working and for what position?

A: I am working at the _______________.

5. Why are you present here today?

A: I am here today to execute my Judicial Affidavit in

relation to the Petition for Nullity of Marriage filed by Petitioner
_______________.

6. Q: Do you know the Petitioner in the instant case?

A: Yes, Ma’am.

7. Q: How do you know the Petitioner?

A: He is my husband, Ma’am.

8. Do you know the Respondent in the instant case?

A: Yes, Maám.

9. Q: How do you know the Respondent?

A: I am the Respondent in the instant case Ma’am.

10. Q: Do you remember having received a Petition for Nullity of

Marriage?

A: Yes, Maám.
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11. Q: If that petition will be shown to you would you be able to

identify it?

A: Yes, Maám.

12. Q: I am showing to you an petition docketed as ______ is this

the petition you had mentioned?

A: Yes, Maám.

Counsel: May I request that the Petition be marked as Exh. “__”.

13. Q: What did you do after you received such petition?

A: I filed an answer Maám.

14. Q: If that answer will be shown to you would you be able to

identify it?

A: Yes, Maám.

15. Q: I am showing to you a document entitled Answer, is this the

answer you had mentioned?

A: Yes, Maám.

Counsel: May I request that the Answer be marked as Exh. “__”.

16. Q: Have you carefully read and understood all the allegations in
this Answer?

A: Yes, Maám.

17. Q: Do you affirm and confirm the truthfulness and veracity of

all the allegations in this answer?

A: Yes, Maám.

18. Q: The petition claims that you have psychological incapacity.

What can you say about that?

A: I do not agree Maám. I have no psychological incapacity.

19. Q: How will you support that?

A: I have a psychological report attached to my Answer to

prove that I have no psychological incapacity.
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20. Q: I am showing to you a document entitled Psychological

Report, is this the psychological report you had mentioned?

A: Yes, Maám.

Counsel: May I request that the Psychological Report be marked as

Exh. “__”.

21. Q: For what purpose are you executing this Judicial

Affidavit?

A: I am executing this statement as part of my testimony in

the above entitled case.

22. Q: Mrs. Witness, is there anything else you wish to add?

A: None, Ma’am.

IN WITNESS WHEREOF, I have hereunto affixed my

signature this ________________ at _________________.

__________________
Affiant

SUBSCRIBED AND SWORN to before me this

_________________ at _______________. I have identified
affiant through his _______________ issued at
_______________ on ______________ bearing his photograph
and signature.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2019.

ATTESTATION
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I, ATTY. EARLEEN H. DEL ROSARIO, of legal age, Filipino,

and with office address at 18 Plaza Rizal, Poblacion, Caloocan City,
under oath and state that:

1. I conducted the examination of witness, __________, on

__________, in connection with the above-captioned
case.

2. I faithfully recorded or caused to be recorded the questions

that I asked and the answers that the witness gave as stated
in his judicial affidavit.

3. Neither I nor any other person present or assisting the

witness coached him regarding his answer stated in his
Judicial Affidavit.

ATTY. EARLEEN H. DEL ROSARIO

Affiant

SUBSCRIBED AND SWORN to before me this

______________ at _____________, affiant personally
appeared and exhibited to me her Integrated Bar of the Philippines
Identification Card with I.D. No. 73914 and bearing her photograph
and signature.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2019.

Copy furnished:
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__________
Counsel for Petitioner
Address

THE OFFICE OF THE SOLICITOR GENERAL

134 Amorsolo St., Legaspi Village
Makati City

OFFICE OF THE CITY PROSECUTOR

Caloocan City