REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ________________________ )
CITY OR MUNICIPALITY OF ________________________ )S.S.
AFFIDAVIT OF PROTEST
I, ________, Filipino, of legal age, with address at ________, after being duly sworn according to law, hereby depose and state that:
1. I am the driver of the motor vehicle as mentioned below:
Manufacturer or Brand: ________
Registration No.: ________
Plate No.: ________
2. My driver's license number is: ________.
3. While I was driving along: ________, I was flagged down and apprehended by a traffic enforcer named: ________.
4. I was issued a citation ticket with the number: ________, dated ________, and was imposed a fine with a total amount of ₱________ (________). Attached herewith is a copy of the same.
5. Under the citation ticket, it states that I committed the following traffic violations:
________
6. I am contesting the citations of the abovementioned traffic enforcer during the apprehension as well as the accuracy and validity of the fine imposed. Below are the true circumstances when I was apprehended:
________
7. The proof attesting the truthfulness of the foregoing is likewise herewith attached:
________
8. I am executing this affidavit to protest and contest the violations cited in the citation ticket.
9. 5 522282 22 252 25525 22 252 225222822 25828 525 225 85522825 82258 2552282 82 252 82582.
8225885 2585858 588558 885285.
________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of ______________________, 20______ at CITY OR MUNICIPALITY OF ________________________, ________________________
Affiant, ________ personally appeared before me and exhibited to me Postal ID no. ________ which is valid until ________.
Doc. No.: _________;
Page No.: _________;
Book No.: _________;
Series of _________.
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ________________________ )
CITY OR MUNICIPALITY OF ________________________ )S.S.
AFFIDAVIT OF PROTEST
I, ________, Filipino, of legal age, with address at ________, after being duly sworn according to law, hereby depose and state that:
1. I am the driver of the motor vehicle as mentioned below:
Manufacturer or Brand: ________
Registration No.: ________
Plate No.: ________
2. My driver's license number is: ________.
3. While I was driving along: ________, I was flagged down and apprehended by a traffic enforcer named: ________.
4. I was issued a citation ticket with the number: ________, dated ________, and was imposed a fine with a total amount of ₱________ (________). Attached herewith is a copy of the same.
5. Under the citation ticket, it states that I committed the following traffic violations:
________
6. I am contesting the citations of the abovementioned traffic enforcer during the apprehension as well as the accuracy and validity of the fine imposed. Below are the true circumstances when I was apprehended:
________
7. The proof attesting the truthfulness of the foregoing is likewise herewith attached:
________
8. I am executing this affidavit to protest and contest the violations cited in the citation ticket.
9. 5 522282 22 252 25525 22 252 225222822 25828 525 225 85522825 82258 2552282 82 252 82582.
8225885 2585858 588558 885285.
________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of ______________________, 20______ at CITY OR MUNICIPALITY OF ________________________, ________________________
Affiant, ________ personally appeared before me and exhibited to me Postal ID no. ________ which is valid until ________.
Doc. No.: _________;
Page No.: _________;
Book No.: _________;
Series of _________.
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