Document 27

FORM NO.
47
REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT
4th Judicial Region
Nasugbu Batangas
People of the Philippines, CRIMINAL CASE NO:123456

Plaintiff,
-versus- For: THEFT
PONCE V. RUIZ.
Accused.
X- - - - - - - - - - - - - - - - - - - - - - - - - - X
JUDICIAL AFFIDAVIT of ROSE ANN R. AGUILAR
I, ROSE ANN R. AGUILAR, of legal age, Filipino, married, a

business owner, and a resident of Barangay Cumba Lian, Batangas,
and after having been duly sworn to in accordance with law, hereby
deposes and states.
PREFATORY STATEMENT
That the taking of my Judicial Affidavit was administered and

supervised by ATTY. ELAINE R. NIOKO and was done at his Law
Office at J.P. Rizal St. Barangay 2, Lian, Batangas and I am fully
aware and cognizant of the questions asked of me by Atty. Elaine R.
Nioko and my answers thereto are under oath being aware that I may
face criminal liability for false testimony or perjury. I likewise
requested that the questions asked of me be in English as well as my
answers thereto also in English which I speak and understand for
clarity and that the other information and/or requirements of Sec. 3,
A.M. 12-8-8- SC as explained to me by the administering lawyer are
contained in my Judicial Affidavit the rest which reads, to wit:
Q1: Please state your name and other personal

circumstances?
A1: I am Rose Ann R. Aguilar, married, owner of R&A Rice

and Feeds store.
Q2: Why are you here in my office?

A2: I am here to file a complaint against the Mr. Ponce V.
Ruiz.
Q3: Mrs. Witness, you said that you are an owner of a store,
where is it located?
A3: It is in Barangay Cumba Lian, Batangas, beside my

parents house Maam.
Q4: What is your complaint?
A4: I am here to complaint about the act of taking of Mr. Ruiz

of my iPhone 14 plus, iPhone 13 pro and money from our
store on April 13, 2024 at around 3:15 in the afternoon.
Q5: What happen at around 3:15 in the afternoon on April 13,

2024?
A5: At around 3:15 o’clock in the afternoon, me and my

cousin Jun Ramos went back to the store from our house,
which is about 30 meters away from the store. As we
were approaching the store, we saw the accused in the
stock room of our store with the my iPhones in his hand
and taking money from the cash box. At that time, no one
was looking after the store because my husband was
outside, and I stepped out of the store for a while to show
my cousin the kitchen sink that I had asked him to fix.
Q6: How did you know that the accused is committing a

crime?
A6: Because when my cousin Jun Ramos arrived at the store

to check the kitchen sink in our house, before I left the
store, I temporarily closed the doors of the store and the
stock room, as well as its window, leaving my phone and
cashbox hidden under the table. In addition, the stock
room area of our store is located at the back of the store,
and we, the owners, alone have access and allowed to
the stock room area.
Q7: And did you know the persons who stole your belongings,
Mrs. Witness?
A7: Yes, Maam.
Q8 How did you know him?
A8: Because he is a resident of our barangay, Maam.
Q9: What evidence/s can you present to prove this fact?

A9: I caught him in the act while taking the money and my
iPhones from his hand. In addition, the sworn testimony of
my cousin in the Police Station, who was with me at the
time the accused committed the crime.
COUNSEL: Attached here is the original copy of the

Sinumpaang Salaysay ng Testigo, marked as “Exhibit A”.
Q10: What did you do after seeing him taking your phone and
money?
A10: My cousin, Jun Ramos, apprehended the accused, and I

called the barangay immediately, who helped us bring the
accused to the police station.
Q11: Is there anything else you may add to your testimony?
A11: That is all for the meantime, Maam.
IN WITNESS WHEREOF, I have hereunto affixed my signature

this 29th day of April, 2024 at Lian, Batangas, Philippines.
ROSE ANN R. AGUILAR

Affiant
TIN NO. 254-77-110
SUBSCRIBED AND SWORN to before me, this 29th day of April

2024 at Lian, Batangas, by above-mentioned affiant, who exhibited her
valid ID bearing her photo and signature as competent proof of her
identity.
NOTARY PUBLIC/ADMINISTERING OFFICER
Doc. No. _____ ;

Page No. _____;
Book No. _____ ;
Series of 2024.
ATTESTATION
I, ELAINE R. NIOKO with Law Office at J.P. Rizal St. Brgy. 2,

Lian, Batangas, hereby attest that I have conducted and supervised
the examination of the above-named affiant/witness at my office
stated above, and further declared that:
1. I faithfully recorded or caused to be recorded the questions I

asked and the corresponding answers the affiant/witness
gave; and
2. Neither I nor any other person then present or assisting me

coached the affiant/witness regarding the latter’s answers.
IN WITNESS WHEREOF, I have hereunto affixed my signature

this 29th day of April, 2024 at Lian, Batangas, Philippines.
NOTARY PUBLIC
Doc. No. _____ ;

Page No. _____;
Book No. _____ ;
Series of 2024.
VERIFICATION AND CERTIFICATION OF
NON-FORUM SHOPPING
I, ROSE ANNR. AGUILAR, of legal age, after having been duly

sworn in accordance with law, depose and state that:
1. I am the Complainant in the above-stated Criminal Case for

Theft;
2. I caused the preparation and filing of the foregoing Judicial

Affidavit;
3. I have read the contents thereof and the facts stated therein
are true and correct of my personal knowledge and/or on the
basis of copies of documents and records in my possession;
4. I have not commenced any other action or proceeding

involving the same issues in the Supreme Court, the Court of
Appeals, or any other tribunal or agency;
5. To the best of my knowledge, no such action or proceeding

is pending in the Supreme Court, the Court of Appeals or
any tribunal or agency;
6. If I should thereafter learn that a similar action or proceeding

has been filed or is pending before the Supreme Court, the
Court of Appeals, or any other tribunal or agency, I
undertake to report that fact within five (5) days therefrom to
this Honorable Court.
ROSE ANN R. AGUILAR

Affiant
TIN ID NO. 678910
SUBSCRIBED AND SWORN to before me, this 28th day of April

2024 at Lian, Batangas, by above-mentioned affiant, who exhibited his
valid ID bearing his photo and signature as competent proof of his
identity.
NOTARY PUBLIC
Doc. No. _____ ;

Page No. _____;
Book No. _____ ;
Series of 2024.
EXHIBIT A
REPUBLIKA NG PILIPINAS)
MUNISIPALIDAD NG LIAN )) S.S.
SINUMPAANG SALAYSAY NG TESTIGO
AKO, si JUN P. RAMOS nasa wastong gulang, may asawa,

Pilipino, at kasalukuyang nakatira sa Barangay Cumba, Lian,
Batangas matapos manumpa ng naaayon sa batas, ay malaya at
kusang loob na nagsasaad ng mga sumusunod:
1. Na ako ay pinsan ng nagrereklamo na si Rose Ann

Ramos Aguilar at may ari ng R&A Rice and Feeds
Store;
2. Na aking kilala ang akusado na si PONCE V. RUIZ,

sapagkat siya ay isa din residente ng aming barangay;
3. Na bago kami umalis ng tindahan ng nagrereklamo ay

nakita ko na isinarado niya ang mga pinto ng tindahan
at stock room pati na ang bintana.
4. Na noong, Abril 13, 2024, noong mga oras na higit

kumulang na ika - 3:15 ng hapon, matapos namin
matingnan ang ipapaayos ng aking pinsan na
nagrereklamo ang lababo sa kanilang bahay, kami ay
sabay naglakad pabalik sa kanilang tindahan ng Bigas
at Feeds, ako para umuwi ng bahay na kalapit lamang
ng tindahan at ang aking pinsan upang magbantay.
5. Na ng kami ay papalapit na sa tindahan ay nakita namin

ang akusado sa stock room ng tindahan na hawak ang
cellphone ng aking pinsan at nasa aktong kumukuha
ang pera mula sa cashbox. Kung kaya agad ko siyang,
sinunggaban upang hindi ito makatakas;
6. Na matapos kung mapigilan makatakas ang akusado ay

agad na tumawag ng tulong sa pamunuan ng aming
baranggay;
7. Na noong dumating ang mga opisyal ng barangay ay

kaagad namin dinala ang akusado sa istasyon ng
pulisya.
8. Malaya at kusang loob kong ibinibigay ang salaysay na
ito na walang sino man ang namilit o nanakot upang
patotohanan ang lahat ng naka saad sa itaas at para sa
ano pamang kadahilanang naaayon sa batas.
JUN P. RAMOS
Nagsalaysay
SINUMPAAN AT NILAGDAAN SA HARAPAN KO ngayong

ika-13 ng Abril, 2024 dito sa Bayan ng Lian. Ang nagsasalaysay ay
nagpakita ng kanyang Voter’s ID na may Blg. VIN 1234567810.
NOTARYO PUBLIKO
Doc. No.:_____
Page No.:_____
Book No.:_____
Series of 2024.

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FORM NO.

REPUBLIC OF THE PHILIPPINES

People of the Philippines, CRIMINAL CASE NO:123456

-versus- For: THEFT

JUDICIAL AFFIDAVIT of ROSE ANN R. AGUILAR

I, ROSE ANN R. AGUILAR, of legal age, Filipino, married, a

That the taking of my Judicial Affidavit was administered and

Q1: Please state your name and other personal

A1: I am Rose Ann R. Aguilar, married, owner of R&A Rice

Q2: Why are you here in my office?

A3: It is in Barangay Cumba Lian, Batangas, beside my

Q4: What is your complaint?

A4: I am here to complaint about the act of taking of Mr. Ruiz

Q5: What happen at around 3:15 in the afternoon on April 13,

A5: At around 3:15 o’clock in the afternoon, me and my

Q6: How did you know that the accused is committing a

A6: Because when my cousin Jun Ramos arrived at the store

A7: Yes, Maam.

Q8 How did you know him?

A8: Because he is a resident of our barangay, Maam.

Q9: What evidence/s can you present to prove this fact?

COUNSEL: Attached here is the original copy of the

A10: My cousin, Jun Ramos, apprehended the accused, and I

Q11: Is there anything else you may add to your testimony?

A11: That is all for the meantime, Maam.

IN WITNESS WHEREOF, I have hereunto affixed my signature

ROSE ANN R. AGUILAR

SUBSCRIBED AND SWORN to before me, this 29th day of April

NOTARY PUBLIC/ADMINISTERING OFFICER

Doc. No. _____ ;

I, ELAINE R. NIOKO with Law Office at J.P. Rizal St. Brgy. 2,

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

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

IN WITNESS WHEREOF, I have hereunto affixed my signature

Doc. No. _____ ;

I, ROSE ANNR. AGUILAR, of legal age, after having been duly

1. I am the Complainant in the above-stated Criminal Case for

2. I caused the preparation and filing of the foregoing Judicial

4. I have not commenced any other action or proceeding

5. To the best of my knowledge, no such action or proceeding

6. If I should thereafter learn that a similar action or proceeding

ROSE ANN R. AGUILAR

SUBSCRIBED AND SWORN to before me, this 28th day of April

Doc. No. _____ ;

SINUMPAANG SALAYSAY NG TESTIGO

AKO, si JUN P. RAMOS nasa wastong gulang, may asawa,

1. Na ako ay pinsan ng nagrereklamo na si Rose Ann

2. Na aking kilala ang akusado na si PONCE V. RUIZ,

3. Na bago kami umalis ng tindahan ng nagrereklamo ay

4. Na noong, Abril 13, 2024, noong mga oras na higit

5. Na ng kami ay papalapit na sa tindahan ay nakita namin

6. Na matapos kung mapigilan makatakas ang akusado ay

7. Na noong dumating ang mga opisyal ng barangay ay

SINUMPAAN AT NILAGDAAN SA HARAPAN KO ngayong

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