MCF No. 3.

21
Litigate as Pauper

Original – Court, 1st Copy – Plaintiff, 2nd Copy – Defendant, Other copies as needed
Enter information in block letters in all parts of the Form except when reserved for Court
use, which shall be completed by the Clerk.
For Court Use Only
(Judicial Region)

(Municipality/City/Province)

 METC/MTCC/MTC/MCTC
 RTC

BRANCH
Case No.
Plaintiff/
Petitioner , v.
Defendant/
Respondent

COUNSEL OR PARTY WITHOUT COUNSEL

Nam
e
Firm Name
Address
Email Address
Tel./Cel./Fax Nos.
PTR No. Date/
Roll No. Place of Issue
 Lifetime
IBP No.  Date/Chapter
 Compliance
MCL  Exemption No
E .
Other Compliances
Counsel for
 Plaintiff/
Petitioner
 Defendant/
Respondent
 Other

MOTION TO LITIGATE AS AN INDIGENT PARTY

UNDER RULE 3.21

____________________________ moves to litigate as an

(name of party)

indigent party and states:

1. Movant cannot afford to pay the required docket and other

lawful fees because movant:

is a client of the Public Attorney’s Office;

is not a client of the Public Attorney’s Office and

A. Employment

page 1 of 3
 is jobless and has no means of livelihood;
is employed, but the gross salary received by the movant
and the movant’s immediate family is not sufficient for
movant’s and family’s support since it is
 not more than P4,000.00 a month and movant is a
resident of Metro Manila;
 not more than P3,000.00 and movant resides outside of
Metro Manila;

AND

B. Property

has no real property;

has real property but its assessed value is not more than
P50,000.00.

2. Attached to this motion in support of the movant’s prayer are

the following documents:

Proof of Monthly Salary (if employed)

Certification from the Assessor’s Office
Barangay Certification of Indigency
Affidavit of Applicant
Affidavit of Disinterested Person
Others ________________________________

PROOF OF SERVICE
A copy of this Motion was served upon:
Party/Counsel’s Name Method Place Served Date Served
Personal Service
Licensed Courier
Registered Mail
Facsimile or Other
Electronic Means
Personal Service
Licensed Courier
Registered Mail
Facsimile or Other
Electronic Means
Personal Service
Licensed Courier
Registered Mail
Facsimile or Other
Electronic Means
Personal Service
Licensed Courier
Registered Mail
Facsimile or Other
Electronic Means
Proof of such service is attached to this Motion as an Annex.

_________________________________ ________________________________________
Date Signature of Party/Counsel

MOTION TO LITIGATE AS AN INDIGENT PARTY page 2 of 3

 ORDER

After a review of the Motion, the same is

 granted. Movant is exempt from the payment of filing and other

fees except the mandatory deposit for the Sheriff’s Trust Fund
and the mediation fee.
 denied because it is deficient.
 set for hearing on ______________________.
(date)

____________________ _______________
Judge Date

SPECIAL INSTRUCTIONS

MOTION TO LITIGATE AS AN INDIGENT PARTY page 3 of 3