REPUBLIC OF THE PHILIPPINES

MUNICIPAL TRIAL COURT IN CITIES

NATIONAL CAPITAL REGION
BRANCH 123,
PASIG CITY
PEOPLE OF THE PHILIPPINES
Plaintiff

CRIM CASES NO.1234567-89-TG

- versus JUAN DE LA CRUZ

Accused.
x---------------------------------------------------x

FOR: ATTEMPTED HOMICIDE

JUDICIAL AFFIDAVIT
I, BEVERLY A. AZUCENA, Filipino, of legal age, married/married, with residence
address address at ________________________________________, and with current
employment as __________________________________, after having been duly sworn in
accordance with law, do hereby depose and state that:
I am executing this judicial affidavit to serve as my testimony in direct examination for
the Plaintff/Prosecution/Defendant/Accused, in relation to the above-entitled cases, pursuant to
A.M. No. 12-8-8-SC, this _____day of __________ at ____________________ under the
supervision of Atty. ___________________ of __________________________, in question and
answer form, under oath and under the pain of contempt and perjury, as follows:
QUESTION No. 1 (Q1): What is your current profession?
Answer (A):
Q2: Where did you go for medical school?
A:
Q3: How long have you been practicing your profession?
A:
Q4: Where are you presently employed?
A:
Q5: What position do you currently hold?
A:
Q6: What are the principal functions and duties of your position?
A:
Q7: Have you examined gunshot victims or persons alleging to be gunshot victims before?
A:

Q8: Have you been qualified to testify as expert in the past?

A:
Q9: Where are you currently assigned?
A:
Q10: Where were you assigned on April of 2012?
A:
Q11: What position did you hold then?
A:
Q12: What were the principal functions and duties of that position?
A: (Prepare Clinical Abstract/Medical Certificate?)
Q13: I have here a 3-page Medical Certificate dated April 14, 2012 from the City Health Office,
was this one of those Medical Certificate you have prepared?
A:
Q14: If I show you such a document will you be able to identify it?
A:
Q15: I am showing to you the document entitled Clinical Abstract, What is this document about?
A:
Q16: At the bottom left hand side of the third page, there appears to be a name, Beverly A.
Azucena, M.D.,FPPA. Whose name is this?
A:
Q17: At the bottom left hand side of the third page, there appears to be a signature above the
name Beverly A. Azucena, M.D.,FPPA. Whose signature is this?
A:
Q18: Who is the other signatory Ms. Alma Maunahan-Roxas?
A:
Q19: What is your relation to her?
A:
Q20: What is your relation to the Patient?
A:
Q21: What is the purpose of the document you prepared?

A:
Q22: What is the procedure in preparing the document?
A:
Q23: May you please explain to the court your findings as it appears in that report?
A:
Q24: What are your basis for these findings?
A:
Q25: Based on the findings as to the physical exams, what was your diagnosis?
A:
Q26: Based on the other findings as to the mental and psychological examinations, what was
your diagnosis?
A:
I attest to the truthfulness of the foregoing answers.
In truth whereof, I have hereunto set my hand this ____ day of January 2013 in
____________________.

BEVERLY A. AZUCENA
Witness-Affiant

Subscribed and sworn to before me this ___ day of June 2011 in ____________________
with the affiant exhibiting to me her Identification Card No. ____________________ issued on
____________________ by ____________________. I hereby certify that the witness-affiant
have read and understood the contents of his affidavit and that she freely and voluntarily made
the same. Further, I hereby attest I have faithfully recorded or caused to be recorded the
questions asked and the corresponding answers given in this judicial-affidavit and that the
witness-affiant have never been coached by any person assisting or present during the conduct of
this judicial-affidavit.