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Republic of the Philippines IN THE MUNICIPAL TRIAL COURT OF __MUNICIPALITY__ _________ Judicial Region B anch _____! __ Municipalit"__ ______________________!

Plaintiff! Ci#il Case No$ _____________ % #e sus % &'esignation of the Pleading( ______________________! Defendant! )%%%%%%%%%%%%%%%%%) (Complaint for Collection of Sum of Mone ! &CAPTI*N( COMPLAINT C*M+, N*- Plaintiff! b" counsel and to this .ono able Cou t! espectfull" states that/ 0$ Plaintiff _____________ is of legal age! 1ilipino! &single 2 3a ied 2 4ido4(! and a esident of _____________! Philippines$ 1o pu poses of this action! plaintiff 3a" be se #ed 4ith all o de s! notices! and othe p ocesses of this .ono able Cou t th ough the office add ess of the unde signed counsel indicated belo45 6$ 'efendant _____________! of legal age! 1ilipino! &single 2 3a ied 2 4ido4(! and 3a" be se #ed 4ith su33ons and othe p ocesses of this .ono able Cou t at his last 7no4n add ess at _____________! Philippines5 8$ ,o3eti3e on _____________! 'efendant obtained f o3 and 4as g anted a loan acco33odation b" the Plaintiff in the p incipal a3ount of

__________________________ &P_____________(! Philippine Cu enc"5 9$ A t ue and faithful 3achine ep oduction of the P o3isso " Note 3ade b" the 'efendant on _____________ is he eto attached as Anne) :A:5

;$ As of _____________! 'efendant still has an *utstanding Balance to Plaintiff a3ounting to __________________________ &P_____________(! Philippine Cu enc"! and has failed and neglected to pa"! 4ithout <ust and #alid g ounds! the said *utstanding Balance fo the afo e3entioned loan acco33odation5 =$ 'espite Plaintiff>s epeated de3ands! both 4 itten and #e bal! 'efendant failed! neglected and efused! and continues to fail and efuse to pa" and to settle the said *utstanding Balance! 4ithout <ust and #alid g ounds! to the continued da3age and p e<udice of Plaintiff5 ?$ A t ue and faithful 3achine ep oduction of the Plaintiff>s de3and lette to 'efendant dated _____________ is he eto attached as Anne) :B:5 @$ ConseAuentl"! Plaintiff 4as const ained to engage the se #ices of counsel to 4ho3 it obligated itself to pa" as Atto ne">s 1ees the a3ount eAui#alent to _____________ &______B( pe cent of the total a3ount due f o3 'efendant to Plaintiff$ PRA"ER #HEREFORE! afte due notice and hea ing! Plaintiff espectfull" p a"s that <udg3ent be ende ed against the 'efendant as follo4s/ 0$ * de ing the 'efendant to pa" Plaintiff the $um$ of/ a$ The a3ount of __________________________ &P_____________(!

ep esenting 'efendant>s *utstanding Balance plus inte est at the ate of _____________ &_____B( pe 3onth as stipulated upon in the P o3isso " Note5

b$

_____________ &_____B( pe cent of the total a3ount due as Atto ne">s 1ees plus Appea ance 1ee at the ate of P__________ pe cou t hea ing 2 confe ence5

c$

_____________ &_____B( pe cent of the total a3ount due as Collection Cha ges 2 LiAuidated 'a3ages5

d$

The costs of suit$ eliefs as 3a" be <ust and eAuitable in the

6$ Plaintiff espectfull" p a"s fo such othe p e3ises$ 'ate _____________! Philippines! __'ate__$

(COUNSEL! %ERIFICATION R+PUBLIC *1 T.+ P.ILIPPIN+,( P o#ince of ____________________( ,$,$ Cit"2Municipalit" of _____________( )%%%%%%%%%%%%%%%%%%%%%%%) I! _____________! of legal age! 1ilipino! &single 2 3a ied 2 4ido4(! and a esident of _____________! Philippines! afte being s4o n in acco dance 4ith la4! he eb" depose and sa"/ That I a3 the &Plaintiff 2 Co3plainant 2 Petitione ( in the abo#e%entitled case5 That I ha#e caused the p epa ation of the abo#e &Co3plaint 2 Petition( and I ha#e ead the sa3e and 7no4s the contents the eof5 That the allegations contained the ein a e t ue and co ect of 3" o4n pe sonal 7no4ledge$ IN #ITNESS #HEREOF! I ha#e he eunto set 3" hand this _____________ at _____________! Philippines$

A11IANT

SU&SCRI&E' AN' S#ORN to befo e 3e! this _____________! b" _____________ 4ho e)hibited to 3e &his2he ( Co33unit" Ta) Ce tificate No$ _____________ issued at _____________! Philippines on _____________$

N*TARY PUBLIC 'oc$ No$ ______5 Page No$ ______5 Boo7 No$ ______5 ,e ies of ______5

CERTIFICATION OF NON(FORUM SHOPPIN) R+PUBLIC *1 T.+ P.ILIPPIN+,( P o#ince of ____________________( ,$,$ Cit"2Municipalit" of _____________( )%%%%%%%%%%%%%%%%%%%%%%%) I! _____________! of legal age! 1ilipino! &single 2 3a ied 2 4ido4(! and a esident of _____________! Philippines! afte being s4o n in acco dance 4ith la4! he eb" depose and ce tif" that/ &a( I ha#e not the etofo e co33enced an" othe action o p oceeding o filed an" clai3 in#ol#ing the sa3e issues o 3atte in an" cou t! t ibunal! o Auasi%<udicial agenc" and! to the best of 3" 7no4ledge! no such action o p oceeding is pending the ein5 &c( if I should the eafte lea n that the sa3e o si3ila action o p oceeding has been filed o is pending befo e the ,up e3e Cou t! the Cou t of Appeals! o an" othe t ibunal o Auasi%<udicial agenc"! I unde ta7e to epo t such fact 4ithin fi#e &;( da"s the ef o3 to the cou t o agenc" 4he ein the o iginal pleading and s4o n ce tification conte3plated he ein ha#e been filed$ IN #ITNESS #HEREOF! I ha#e he eunto set 3" hand this _____________ at _____________! Philippines$ A11IANT SU&SCRI&E' AN' S#ORN to befo e 3e! this _____________! b" _____________ 4ho e)hibited to 3e &his2he ( Co33unit" Ta) Ce tificate No$ _____________ issued at _____________! Philippines on _____________$

N*TARY PUBLIC 'oc$ No$ ______5 Page No$ ______5 Boo7 No$ ______5 ,e ies of ______5