REPUBLIC OF THE PHILIPPINES] S.S.

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx]

AFFIDAVIT-INCIDENCE REPORT

I, xxxxxxxxxxxxxxx , Filipino citizen, of legal age, single,

and a resident of Barangay xxxxxxxxxxxxxxxx, after having been
duly sworn in accordance with law, hereby depose and say:

1. That on June 30, 2017 at 7:30 in the morning, while having

breakfast in the maternal ancestral house where I reside, I
heard some noise from outside of my residence, shouting,
“Ayo! Ayo!”, I look out the window and thereafter saw one
certain xxxxxxxxxxxxxxxx together with four other unidentified
men.
2. That out of good will and respect to his person being known to
me, I asked my house helper, a certain xxxxxxxxxxx to open
the gate to allow them entrance.
3. That as xxxxxxx opened the gate, xxxxxxxxxxx arrived and
together with Jun and the abovementioned companions,
entered the house and demanded that the door of the second
floor of the house be opened, to which xxxxxxxx complied.
4. That xxxxxxxxxxx said to me “Dong, magkuha ko og katre,
nagsabot na mi sa imong Uncle xxxxxxxx”. Hearing that, I
posed no objection since xxxxxxxxx is a xxxxxxxxxx.
5. That to my surprise, xxxxxxxx did not only transported the
bed, rather included one antique wooden sala set and two (2)
antique wooden dining chairs and conveyed the same in
vehicle (elf) outside the gate . Attached herewith are the photos
taken from the said incident.
6. That I resisted and objected to the inclusion of other things
aside from the bed by saying “Ayaw lang pod dad-a nang mga
lingkuranan, auntie kay gamiton namo kon mag death
anniversary dinhi sa balay.’ Nonetheless, my plea fell into
deaf ears and they successfully brought out those
aforementioned furniture without my approval and consent.
7. That I execute this affidavit for all legal intents and purposes.

Further Affiant sayeth none.

IN WITNESS WHEREOF, I have hereunto affixed my

signature this ......... day of ..................... , 20__ in
..................................... Philippines.
 xxxxxxxxxxxxxxxxxxxxxxxxxxxx

Affiant

SUBSCRIBED AND SWORN to before me in the

Municipality of xxxxxxxxxx this ____ day of ________________ by
xxxxxxxxxxxxxxxxxxx, personally known to me, who is the same
person who personally signed before me the foregoing affidavit and
acknowledged that he executed the same.

Doc. No. .........:

Page No. .........;
Book No. .........;
Series of 20__.