HLURB Case Form No.

02

Republic of the Philippines

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

______________________________,
Complainant/s,

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

______________________________,
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)

3. This complaint is for: (Please check as are applicable).

[ ] Violation of Republic Act No. 9904 (Magna Carta of Homeowners and Homeowners
Complaint, Page 1
 Associations) and/or Its Implementing Rules and Regulations, particularly the following
sections:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

[ ] Violation of the Association’s By-Laws, particularly the following Articles/Sections:

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

[ ] Breach of or failure to comply with 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 :
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

Complaint, Page 2
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

(2) Alleged Violation : ____________________

Narration of facts/incidents/circumstances :
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

(3) Alleged Violation : ____________________

Narration of facts/incidents/circumstances :
Complaint, Page 3
 ______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
(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”__ ____
_____ ____
_____ ___
___
_____ ____
_____ ____
_____ ___
___
_____ ____

Complaint, Page 4
 _____ ___
_____ ____
_____ ___
___
_____ ____
_____ ___
_____ ____
_____ ____

(Note: If more space is needed, please use additional sheet, indicate “Continuation of Par. 5” and countersign)

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:
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
Complaint, Page 5
 ______________________________________________________________

______________________________________________________________
______________________________________________________________
_____________________________________________________________
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)

________________________ _________________________

________________________ _________________________

________________________ _________________________

________________________ _________________________

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
_________________.

Complaint, Page 6
Doc. No. ______; Notary Public
Page No. ______;
Book No. ______;
Series of ______.

Complaint, Page 7