REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

REGION VII
BRANCH 123
CEBU CITY

JUANA DELA CRUZ CIVIL CASE NO. 12345

Petitioner,

versus
JUAN DELA CRUZ FOR: NULLITY OF MARRIAGE
Respondent.
x--------------------------x

JUDICIAL AFFIDAVIT OF
PETITIONER

I, JUANA DELA CRUZ , of legal age, married, and living at ________________, Cebu City,
petitioner in this case, after having been duly sworn, hereby attests that:

PRELIMINARY STATEMENT

The person examining me is Atty. May Pagasa with office address at _____________
Cebu City. The examination is being held at the same address. I am answering her
questions fully conscious that I do so under oath and may face criminal liability for
false testimony and perjury.

PURPOSE: This affidavit/testimony of petitioner JUANA DELA CRUZ is being offered

to prove that the respondent JUAN DELA CRUZ ______________________________.

1. Q. Please state your name and other personal circumstances for the record.
A. JUANA DELA CRUZ

2. Q. Are you the same JUANA DELA CRUZ, the petitioner in this case?
A. Yes sir.

3. Q. Do you know a certain JUAN DELA CRUZ?

A. Yes sir. He was the man I married on _____________.

4. Q. How did you meet respondent JUAN DELA CRUZ?

A. ____________________________________.
 5. Q. Are you still cohabiting with JUAN DELA CRUZ?
A. No, we have been living separately for five (5) years now since ___________.

6. Q. Do you have of proof your marriage with JUAN DELA CRUZ?

A. Yes sir, I have a NSO Certified marriage contract as my Exhibit "A"

7. Q. Did you have children with JUAN DELZ CRUZ?

A. No, we have no children.

8. Q. What is the reason for your separation?

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of 2015 at Cebu
City.
___________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for the city of Cebu this
____th day of ____________ 2015. Affiant personally came and presented to me
her ___________________ ID issued by the ________________ on 2012 at Cebu City, as
valid and competent proof of her identity, known to me as the same person who personally
signed the foregoing judicial affidavit before me and avowed under penalty of law to the
veracity of the contents of said instrument.

___________________________________________
Notary Public

Doc. No. ____

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