REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

NATIONAL CAPITAL JUDICIAL REGION
MAKATI CITY, BRANCH 61

________________ ,
Plaintiff
Criminal Case No. __-____
- versus - For: Murder

_____________ ,
Accused.

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

PANG-HUKUMANG SINUMPAANG SALAYSAY NI _______

Ako si ____________, Filipino, _____ taong gulang, civil sttus, at

nakatira sa ___________, pagkatapos kong manumpa na naayon sa
batas, ay sumasagot sa mga tanong ni Atty. ______________, na may
opisina sa ___________________. Aking ding sinasaad sa ilalim ng
parusang pagsira sa banal na pangako (perjury) na sa pagsagot sa mga
tanong sa akin, na makikita sa ibaba, lubos kong alam na ang
pagsasalaysay kong mga iyon ay naayon sa ilalim ng panunumpa sa
batas at na ako ay maaring maharap sa kriminal na pananagutan para
sa pagsira sa banal na pangako (perjury). Ang mga tanong at sagot ay
ay nakasulat sa Filipino, ang wika na aking naiitindihan.

Offer of Testimony:

The testimony of __________ is being offered for the purpose of

showing the following:

Salaysay:

1. Q:
A:

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 NAME OF WITNESS (THEN ASK TO SIGN)

Warranty (only if there are documents attached to the JA)

Ako ay sumusumpa na ang mga nakalakap na dokumento sa pang-

hukumang salayasay na ito ay tunay na kopya ng mga orihinal na
dokumento.

NAME OF WITNESS (THEN ASK TO SIGN)

SUBSCRIBED AND SWORN to before me, a Notary Public in and for

_______City, affiant exhibiting to me his ___________ and expiring on
__________, who was identified by me through competent evidence of
identity to be the same person who presented the foregoing instrument
and signed the instrument in my presence, and who took an oath
before me as to such instrument.

Witness my hand and seal this ___________.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018.

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 Attestation

I, ATTY. ______________, after having been sworn in accordance with

law, hereby depose and state:

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

asked and the corresponding answers that the witness,
_________, gave; and

2. Neither I nor any other person then present or assisting me

coached the witness, _________, regarding his answers.

___________________

SUBSCRIBED AND SWORN to before me, a Notary Public in and for

_____, affiant exhibiting to me his ___________ and expiring on
___________, who was identified by me through competent evidence
of identity to be the same person who presented the foregoing
instrument and signed the instrument in my presence, and who took
an oath before me as to such instrument.

Witness my hand and seal this day of ______________.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018.

DE GUZMAN SAUL LAW FIRM

Counsel for Martin Montenegro III
, Ground Floor
Building
Rockwell Center, Makati City 1200
Tel. No.: (632) loc.
Fax No.: (632)

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 By:

BEATRICE ANNE DC. DE GUZMAN

Roll of Atty. No. 09985
IBP Lifetime No. 12345; 2/11/20016; RSM
PTR No. MKT09985652; 2/10/2018; Makati
MCLE Compliance No. V–2011318; 8/8/2016
Mobile No. +63 998 5652998
Email: deguzman.bea@gmail.com

pau
Roll of Atty. No. 56529
IBP Lifetime No.; 2/11/20016; RSM
PTR No. MKT09985652; 2/10/2018; Makati
MCLE Compliance No. V–2012118; 9/8/2016
Mobile No.
Email:

Copies furnished:

ATTY. GLENN BY HAND

City Prosecutor
_____________, ___________
________
___________, _______ City

ATTY. CHESKA BY HAND

Asst. Prosecutor
_____________, ___________
________
___________, _______ City

ATTY. RC BY HAND
Private Prosecutor
_________ Law
________________________