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Page (pahina) 1
REPUBLIC OF THE PHILIPPINES
NATIONAL CAPITAL JUDICIAL REGION
METROPOLITAN TRIAL COURT OF PARAÑAQUE
HERRERA ERICK ,
Defendant.
x---------------------x
STATEMENT OF CLAIM
(HABLA NG PAGSINGIL)
HOME ADDRESS:(City) 8130 Dioviic Bldg Dr A Santos San Dionisio P’que City
(Pahatirang Sulat sa Bahay) [Lungsod] Zip Code
HOME ADDRESS:City) 8130 Dioviic Bldg Dr A Santos San Dionisio P’que City
(Pahatirang Sulat sa Bahay) [Lungsod] Zip Code
HOME ADDRESS: (City) 148 PAMBERTO ST., DELA CRUZ CMPD SAN ISIDRO PQUE CITY
(Pahatirang Sulat sa Bahay) [Lungsod] Zip Code
*Note: If you need more space, you can write at the back of this Form.
(*Tala: Kung kailangan mo ng karagdagang patlang, maaari mong isulat sa
likod ng Form na ito.)
FORM 1-SCC
Page (pahina) 4
(c) How did you compute the money owed to you? (Do not include court
costs or fees) MA X Terms ( 1,514 X 34 = 51,476.00
3. (a) Did you ask the defendant to pay you before you filed this case?
(Siningil mo ba ang Hinahabla bago ka nagsampa ng kasong ito?)
6-A. In this court station, how many small claims cases have
you filed within this calendar year prior to this present case?
______________
(Sa court station na ito, pang ilang kaso na itong isinampa mo
sa loob ng kasalukuyang taon? ______)
PRAYER
(PAGSAMO)
_____ ___
PLAINTIFF
(Naghahabla)
FORM 1-SCC
Page (pahina) 7
RONALD CATINDIG
Affiant
NOTARY PUBLIC
____________________________
*Cross out inapplicable provision