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FORM 1.

PARTNER INFORMATION FORM


Name of Partner: ISIDRO BETONIO Age: 74
Citizenship: FILIPINO Sex: M
Civil Status: MARRIED
If married, name of FELOMINA BETONIO
spouse:
Home Address: P3, A. LUNA, CABADBARAN AND Tel. No.
Place of Work: Tel. No.
Alternative Contact
Nos.

VENUE (check where case if filed or where potential case will be filed)___________________________

NATURE OF THE CASE(check nature of pending case or potential case)


Civil / Criminal Labor Others: ________________

NATURE OF ASSISTANCE REQUESTED


Legal Representation
Legal Advice //
Drafting of pleading/affidavit/letter/other documents
Others: ___________________________________________

INDIGENOUS PEOPLES’ INDICATORS (Partner’s Indicator)


Place of Residence:
Membership in a clan:
Certification or any document referring to
his membership of a tribe:
Relevancy of case to IPRA and other related
concerns:

INDIGENCY
Usual Occupation of partner:
(state also nature of employment:
employees, self-employed, regular, casual
probationary, etc)
Other source of Income:
Average monthly salary:
No. of children/other dependents:
No. of children in school:
No. of children working:
Where children are studying or working:
If children are working and supporting
partner, how much support do they give, if
any:
Other financial indicators:
(owns or rents house, amount of rent, type
of vehicle, if any, certificate of indigency
from DSWD or local government, etc.)

Title of the Case: ____________________________________ Case No. ________________


Represented by Counsel: Yes No
Status of Engagement: On-going Terminated
If terminated, reason for termination: __________________________________________________
If on-going, reason for application with ULAP: ____________________________________________

Name:
Address:
Tel. No. of Counsel:

Designation of Partner
Plaintiff/Complainant
Respondent/Defendant
Others: _________________

Name and Contact No. of Opposing Party:


Name and Contact No. of Counsel of the
Opposing Party:
Referred to ULAP by:

ULAP TRANSACTION

Interviewed by: _______________________________________ Date: _________________________

Recommendation/Remarks: (attach Case Summary Report)


SETTLEMENT ON GOING
(TO WAIT FOR THE MONTH OF SEPTEMBER)

INFORMATION REQUESTED BELOW THIS LINE TO FILL OUT BY ULAP STAFF

Application Accepted Date Accepted: ____________________


Application Denied Date Denied: ____________________

Reasons for acceptance/denial:


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Supervising Lawyer/Volunteer Lawyer Assigned: _____ATTY. GLAIZA LAGUNDE______________