HLURB Case Form No.

01

Republic of the Philippines

Office of the President
HOUSING AND LAND USE REGULATORY BOARD
_____________________ Regional Field Office
______________________________________
______________________________________

______________________________,
Complainant/s,

- versus - HLURB Case No. REM -______-______________

______________________________,
Respondent/s.
x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - x

COMPLAINT

1. The complainant/complainants is/are:

Name Sex/Age/Nationality Address Contact No.

(Note: If more space is needed, please use additional sheet, indicate “Continuation of Par. 1” and countersign)

2. The respondent/respondents is/are:

Name Position (if applicable) Address

(Note: If more space is needed, please use additional sheet, indicate “Continuation of Par. 2” and countersign)

Complaint, Page 1
3. This complaint is for: (Please check as are applicable).

[ ] Violation of Presidential Decree No. 957:

_____ Selling of subdivision lots/ condominium units without license to sell (Sec.5)
_____ Mortgage of title without clearance (Sec. 18)
_____ Failure to provide facilities advertised (Sec. 19 and 20)
_____ Non-development (Sec. 20)
_____ Incomplete Development (Sec. 20)
_____ Unauthorized alteration of plan (Sec. 22)
_____ Non-delivery of title (Sec. 25)
_____ Collection of real estate tax prior to buyer’s occupation (Sec. 26)
_____ Unauthorized collection of dues by project owner/developer (Sec. 27)
_____ Illegal use of open space (Sec. 31 as amended by PD 1216)
_____ Others:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

[ ] Violation of RA 6552 (Maceda Law)

_____ Cancellation of contract without factual basis.
_____ Cancellation of contract without complying with grace period or notice requirements
_____ Failure to refund cash surrender value
_____ Others:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

[ ] Breach of specific contractual obligations, particularly the obligation to:

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

[ ] Other acts/violations of the respondent/respondents complained of:

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
(Note: If more space is needed, please use additional sheet, indicate “Continuation of Par. 3” and countersign)

4. The above violations were committed as follows: (For each violation checked or cited above, briefly
and clearly narrate the facts, incidents or circumstances that led to the filing of this complaint, stating
the dates of occurrence, persons involved and specific acts done by the respondent/respondents.):

(1) Alleged Violation : ____________________

Narration of facts/incidents/circumstances :
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Complaint, Page 2
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(2) Alleged Violation : ____________________

Narration of facts/incidents/circumstances :
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(3) Alleged Violation : ____________________

Narration of facts/incidents/circumstances :
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Complaint, Page 3
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(Note: If more space is needed, please use additional sheet, indicate “Continuation of Par. 4” and countersign)

5. As evidence of the foregoing facts and circumstances, I/we are attaching the following documents
and affidavits as annexes to this complaint:

Annex Description of Document Purpose of Document (What fact or circumstance

does the document prove or show?)
_”A”__ ____
_____ ____
_____ ___
___
_____ ____
_____ ____
_____ ___
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(Note: If more space is needed, please use additional sheet, indicate “Continuation of Par. 5” and countersign)

Complaint, Page 4
6. Complainant/complainants is/are seeking the following reliefs:

(1) ___________________________________________________________________________
___________________________________________________________________________
(2) ___________________________________________________________________________
___________________________________________________________________________
(3) ___________________________________________________________________________
___________________________________________________________________________
(4) ___________________________________________________________________________
___________________________________________________________________________
(5) ___________________________________________________________________________
___________________________________________________________________________

(Note: If more space is needed, please use additional sheet, indicate “Continuation of Par. 6” and countersign)

7. Complainant/complainants also seeks/seek the payment of damages in their favor, and have
attached proof under Paragraph 5 above that they are entitled to them:

____Actual/Compensatory damages in the amount P__________ (Proof attached as Annex “___”)

____Moral damages in the amount of P________________ (Proof attached as Annex “___”)
____Exemplary damages in the amount of P_____________
____Attorney’s fees in the amount of P_________________ (Proof attached as Annex “___”)
____Cost of litigation in the amount of P___________ (Proof attached as Annex “___”)

8. Complainant/complainants also pray that, pending the resolution of the case, the following provisional
remedy be issued in accordance with Part 3 of the 2019 Rules of Procedure of HLURB Rules of
Procedure:

Provisional remedy prayed for: ___________________________________________________

Circumstances justifying the issuance of the provisional remedy:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
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_____________________________________________________________
As proof of these circumstances, we are attaching the following documentary evidence as
Annex/Annexes “_________”

Quezon City, Metro Manila , ___________________(date)

(If there are more than one complainant, each complainant shall sign).

Complainant/Complainants (Signature over printed name)

________________________ _________________________

Complaint, Page 5
 ________________________ _________________________

________________________ _________________________

________________________ _________________________

VERIFICATION AND CERTIFICATION AGAINST FORUM SHOPPING

I/We, (Name/names)_______________________________, of legal age, Filipino / _____________ ,

and a resident of __________________________________________________________________
After having been duly sworn under in accordance with law, hereby depose and state:

1. That I am the complainant/ we are the complainants in the above-entitled case and have caused this
Complaint to be prepared; that I/we read and understood its contents which are true and correct of my/our
own personal knowledge and/or based on true records;

2. That I/we have not commenced any action or proceeding involving the same issue or subject matter
in the Supreme Court, the Court of Appeals or any other tribunal or agency; that to the best of my/our
knowledge, no such action or proceeding is pending in the Supreme Court, the Court of Appeals or any
other tribunal or agency, and that, if I/we should learn thereafter that a similar action or proceeding has
been filed or is pending before these courts or tribunal or agency, I/we undertake to report that fact to
the Court within five (5) days therefrom;

____________________
Complainant

REPUBLIC OF THE PHILIPPINES)

) S.S.

SUBSCRIBED AND SWORN to before me, this ___ day of ______________, with affiant/affiants
exhibiting to me his/her/their _________________________ issued at _______________ on
_________________.

Doc. No. ______; Notary Public

Page No. ______;
Book No. ______;
Series of ______.

Complaint, Page 6