Sample Format of Sworn Statement (Question and Answer)
FREE AND VOLUNTARY STATEMENT BY Mark Jordan Daguro from San Agustin GIVEN
TO THE INVESTIGATION OF Donn Quinson S. Ajido, HERE IN THE OFFICE OF THE Name
and address of the Office, TODAY TH- (Month, Date and Year), AT EXACTLY TH- (Time) OF
THE MORNING/AFFIANT/EVENING, IN THE PRESENCE OF (Name of Witnesses-at least
2). THROUGH QUESTIONS AND ANSWERS.
(The narrator has been informed or reminded of all his rights in accordance with the provisions
of our New Constitution).
QUESTIONS AND ANSWERS
01. QUESTION - Sir Mark Jordan Daguro will you say the whole truth and only the truth
in this investigation?
ANSWER - Yes
02. QUESTION - Are you willing to give your free and willing narrative?
ANSWER - Yes
03. QUESTION - Can you tell this investigation your real name and other identifiers of
your true identity?
ANSWER - Mark Jordan Daguro from San Agustin Isabela
04. Q - What is the reason and you are here in our office and giving your free and
willing account?
A - My relative who was killed.
05. Q - Where and when did such an incident occur?
A - Inside the bus on Tuesday afternoon.
06. Q - How did the shooting happen?
A - I don’t know.
07. Q - How did the shooting happen?
A - While we were riding, there were two men who stood in the back and
pulled something out of their back and shot it, which was my relative.
08. Q - Do you know these victims?
A - Yes
09. Q - In the light of this investigation, can you narrate or say what actually
happened in the incident that occurred?
A - While we were riding, two men stood behind and shot my relatives.
10. Q - As far as you know, how many of the shooters had guns and what calibers
were they?
A - They are all the same and they use the same forty-five caliber
Page 2. Continuation of Mark Jordan Daguro's free and willing narrative on February 8,
2025
11. Q - Besides you, do you know any people who saw such a murder?
A - Yes, there were many of us on that bus.
12. Q - What did you do after you witnessed such an incident?
A - I was scared.
13. Q - If you were to see them again and face them, would you recognize them?
A - Their faces are covered
14. Q - For the time being, I will not ask you anything else, do you have anything
else you want to add or subtract from this story of yours?
A - Its gone.
15. Q - Were you threatened, promised, or given a reward for giving this account?
A - Nope
16. Q - Are you ready to sign this two-page statement of yours?
A - Yes
END OF THE STORY: February 9, 2025
__________________________
Narrator
SUBSCRIBED AND SWORN TO before me this February 8, 2025 at Police Regional
Office 2 PRO2
_________________________
Administering Officer
CERTIFICATION
I HEREBY CERTIFY THAT I have personally examined the herein affiant under oath
and that I am fully satisfied that he/she voluntarily executed and understood his/her statement.
_________________________
Administering Officer
