Friday, January 29, 2016

Sample affidavit for purposes of police blotter


          I, xxx, of legal age, and a resident of xxx, xxx City, under oath, state that:

1.       I am a former incorporator and stockholder of the xxx Inc.  with former office address at xxx, xxx, xxx.

2.     Mr. xxx is a stockholder and the former Operations Manager of the abovereferred corporation.

3.    Sometime in xxx, I, my husband xxx, and Mr. xxx were together for the inspection of the recently completed construction project of our corporation for xxx, located at the xxx Road in xxx City.

4.    The corporation was encountering some collection problems with the President of the xxx due to the alleged delay in the turnover of the abovereferred project.

5.     At that time, Mr. xxx suggested that the problem with the President of xxx be handled thru illegal or criminal means. He said:

Kung ayaw niyang magbayad nung atraso sa atin, may katapat yan.  Singkwenta mil lang yan.  Kahit kayo e. Marami tayong kilalang pulis na xxx”.

6.    In this regard, I remember that sometime xxx, the same xxx had showed us his hand gun during our visit to the same construction project for xxx, and said “Tingnan nyo to.  Lagi akong kargado”.

7.     The relationship between me and my husband xxx and the group of Mr. xxx has turned bad which had resulted in the to “de facto” stoppage of the operations and closure of the said corporation.

8.    Looking back, I and my husband xxx now fear for our lives and our safety, together with our son, because I know that Mr. xxx has the tendency and is capable of inflicting on me, my husband xxx, and our son,  serious physical harm.

9.    I am executing this Sworn Affidavit to state the above facts, to put on record the possible harm to our lives, and for other legal purposes it may serve, e.g. Police Blotter and the like.

Xxx City, xxx.

X x x

Republic of the Philippines

          SUBSCRIBED and SWORN before me this ___ day of xxx, with the Affiant having exhibited to me her xxx expiring on xxx.

                                                                NOTARY PUBLIC
Doc. No. _____
Page No. _____
Book No. _____

Series of 20xx.