[Court]

[Region]
[COURT]
[City], [Branch No.]

[NAME] _______________,
Plaintiff,
Civil/Criminal Case No. ________
- versus - For: ________________

[NAME] ______________,
[ACCUSED/DEFENDANT].
x ---------------------------------------- x

NOTICE OF APPEAL

PLAINTIFF, by counsel, respectfully appeals to the Court of Appeals the Decision of

this Honorable Court dated [DATE] __________________, a copy of which he received on
[DATE], for [STATE REASON FOR APPEAL] _______________________________________.

[CITY] _________; [DATE] ___________.

[SIGNATURE]
[NAME OF COUNSEL] ____________
[ADDRESS] _______________________
IBP Lifetime No. ____________; [CITY] _____________
PTR No. _______________; [DATE], [CITY]
Roll of Attorney No. _______________________
MCLE Compliance No. ____________________

Copy furnished through personal service:

[NAME OF COUNSEL] __________________

Counsel for the [ACCUSED/PLAINTIFF/DEFENDANT]
[FIRM NAME] _______________
[ADDRESS] ________________

[USE THE FOLLOWING IF SERVICE IS NOT MADE PERSONALLY]

Copy furnished through registered mail:

[NAME OF COUNSEL] __________________
Counsel for the [ACCUSED/PLAINTIFF/DEFENDANT]
[FIRM NAME] _______________
[ADDRESS] ________________
Registry Receipt No. ________
Post Office ________________
Date _____________________

EXPLANATION

The foregoing [DESIGNATION OF PLEADING, MOTION, ETC] _______________and

its attachment were served on [NAME OF COUNSEL] ________________ by registered mail
instead of personal service as counsel for petitioner [STATE REASON]
___________________.

[SIGNATURE]
[NAME] _________________

Republic of the Philippines )

City of _______________ ) s.s.

AFFIDAVIT

I, [NAME] ____________ , a messenger of [NAME OF COUNSEL FOR

ACCUSED/PLAINTIFF/DEFENDANT], with office address at [ADDRESS] __________________,
after being duly sworn, deposes and states:

That on [DATE] ______________________, I served a copy of the following

pleadings/papers by registered mail in accordance with Section 10, Rule 13 of the Rules of
Court:

Nature of Pleading/Paper
[STATE PLEADING/PAPER SENT]
________________________

in Case No. [CASE NUMBER] _________________ entitled [TITLE OF CASE]

____________________ by depositing a copy in the post office in a sealed envelope, plainly
addressed to [NAME OF PARTY/ATTORNEY] _______________ at _______________ with
postage fully paid, as evidenced by Registry Receipt No. _____________________ attached
and with instructions to the post master to return the mail to sender after ten (10) days if
undelivered.

TO THE TRUTH OF THE FOREGOING, I have signed this Affidavit on [DATE]

________________, in the City of [CITY] _____________, Philippines.

[SIGNATURE]
[NAME] __________
Affiant

SUBSCRIBED AND SWORN TO before me in the City of _______________ on this day

of [MONTH AND YEAR]_________________, affiant exhibiting before me his Government
Issued ID no. _______________ issued on [DATE}__________________ at [PLACE OF
ISSUANCE]_____________________.

[SIGNATURE]
[NAME]_______
Notary Public

Until [DATE]__________________
PTR No. [NUMBER] ____________
Issued at [PLACE]______________
On [DATE] ___________________

Doc. No.
Page No.
Book No.
Series of [YEAR] ___________.