Professional Documents
Culture Documents
Case Form 01 - REM Complaint
Case Form 01 - REM Complaint
01
______________________________,
Complainant/s,
______________________________,
Respondent/s.
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COMPLAINT
(Note: If more space is needed, please use additional sheet, indicate “Continuation of Par. 1” and countersign)
(Note: If more space is needed, please use additional sheet, indicate “Continuation of Par. 2” 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.):
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Complaint, Page 2
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Complaint, Page 3
(3) Alleged Violation : ____________________
Narration of facts/incidents/circumstances :
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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:
Complaint, Page 4
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(1) ___________________________________________________________________________
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(2) ___________________________________________________________________________
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(3) ___________________________________________________________________________
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(4) ___________________________________________________________________________
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(5) ___________________________________________________________________________
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(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:
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:
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Complaint, Page 5
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As proof of these circumstances, we are attaching the following documentary evidence as
Annex/Annexes “_________”
(If there are more than one complainant, each complainant shall sign).
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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;
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Complainant
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