HLURB Case Form No.

01

Republic of the Philippines

Office of the President
HOUSING AND LAND USE REGULATORY BOARD
Southern Tagalog Field Office IV-A

Rizalinda __ Gauldin,
Complainant,

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

PRIMEROSE PROPERTIES & DEV’T. INC.,

Respondent.
x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - x

COMPLAINT

1. The complainant is:

Name Sex/Age/Nationality Address Contact No.

Rizalinda __ Gauldin Female/__/Filipino

2. The respondent/respondents is/are:

Name Position (if applicable) Address

Primerose Properties Management/President/Chie Unit 1124/1125 City & Land Plaza Bldg.,
&Dev’t. Inc. f Executive Officer and Legal ADB Ave. cor. Garnet St., Ortigas
Depatnment of Primerose Center Pasig City
Properties & Dev’t. iNC.

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

[ ] Violation of Presidential Decree No. 957:

_____ Selling of subdivision lots/ condominium units without license to sell (Sec.5)
_____ Mortgage of title without clearance (Sec. 18)
_____ Failure to provide facilities advertised (Sec. 19 and 20)
_____ Non-development (Sec. 20)
_____ Incomplete Development (Sec. 20)
_____ Unauthorized alteration of plan (Sec. 22)
_____ Non-delivery of title (Sec. 25)
_____ Collection of real estate tax prior to buyer’s occupation (Sec. 26)
_____ Unauthorized collection of dues by project owner/developer (Sec. 27)
_____ Illegal use of open space (Sec. 31 as amended by PD 1216)
_____ Others:
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Complaint, Page 1
 [ ] Violation of RA 6552 (Maceda Law)
_____ Cancellation of contract without factual basis.
_____ Cancellation of contract without complying with grace period or notice requirements
_____ Failure to refund cash surrender value
_____ Others:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

[ ] Breach of 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:
______________________________________________________________

______________________________________________________________
______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________

______________________________________________________________
______________________________________________________________
_____________________________________________________________
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).

Complaint, Page 5
 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
_________________.

Doc. No. ______; Notary Public

Page No. ______;
Book No. ______;
Series of ______.

Complaint, Page 6