Collection for Sum of Money (Small Claim) Submitted to: JUDGE RHODALYN MONTEMAYOR ABAS Submitted by: Basa, Mark Lester Garcia-Sarzadilla, Eisley Merrera, Arsenio II16 A.M. No. 08-8-7-SC FORM1-SCC REPUBLIC OF THE PHILIPPINES WINIOPAL “TRIAL Couey IN CIES FigsT JUOCAL REGION CIN OF URDSNETA Mago BED : Plaintiff, i Civil Case No.__'2= 202) For: COUSCTION” OF SURTOF MONEY LU\GL_ GREEN : Defendant. Xow eec eee e rece rece eee eee x STATEMENT OF CLAIM (HABLA NG PAGSINGIL) 1. The personal circumstances of the parties are as follows: (Ang bawat panig ay ang mga sumusunod) MARIO RED MALE 50 SINGLE NAME OF PLAINTIFF/S SEX AGE CIVIL STATUS (Pangalan ng Naghahabla) (Kasarian) (Edad) (Katayuang Sibil) (Put a check on any of the following) (Pumili sa mga sumusunod at lagyan ng tsek) 1 INDIVIDUAL CORPORATION ["] PARTNERSHIP (Tao/Indibidwal) (Korporasyon) (Bakasan) ©) cooperarive () SOLE PROPRIETORSHIP (Kooperatiba) (Solong Pagmamay-ari)2016 Revised Rules of Procedure for Small Claims Cases 17 NATURE OF BUSINESS: (Uri ng Negosyo) (1 BANKING (7 LENDING (Bangko) (Pagpapautang) (] OTHERS/PLEASE INDICATE, (Iba pang uri ng negosyo) PLAINTIFF’S HOME ADDRESS: (Pahatirang Sulat sa Bahay ng Naghahabla (City) RDANETS CTY 2423 (Lungsod) Zip Code (Province, if applicable)_ PANGASINAN (Lalawigan, kung meron) Zip Code Telephone No. Cellphone No,_O%'24A 46453 (Telepono Big.) (Selpon Ble.) PLACE OF WORK: _STO_DOMINGD, UROANETA CTY (Lugar ng Pinagtatrabahuan) Telephone No.___——————_—Celiphone No,_ OFI24 46453 (Telepono Big.) (Selpon Big.) NAME OF PLAINTIFF'S REPRESENTATIVE: MARK LESTER BAS if applicable (must be a non-lawyer) (Pangalan ng Kinatawan:) (kung meron) [dapat hindi abogado} HOME ADDRESS: (City) _URDANETA CITY 2428 (Pahatirang Sulat sa Bahay) (Lungsod) Zip Code (Province, if applicable) __ PANG ASINAN (Lalawigan, kung meron) Zip Code18 A.M. No. 08-8-7-SC Telephone No. Cellphone No._CO|2494153, (Telepono Big.) (Selpon Blg.) (Selpon Blg.) PLACE OF worK: S10 DOMINCO URDANETA Cry (Lugar ng Pinagtatrabahuan) Telephone No. Cellphone No. QUIZ AFAG4S 3 (Telepono Blg.) (Selpon Big.) LUIGI GREEN MALE 5Y JINGLE NAME OF DEFENDANT/S SEX AGE CIVIL STATUS (Pangalan ng Hinahabla) (Kasarian) (Edad) (Katayuang Sibil) (INDIVIDUAL —_[] CORPORATION (7 PARTNERSHIP (Tao/Indibidwal) (Korporasyon) (Bakasan) CI. CooPpERATIVE SOLE PROPRIETORSHIP (Kooperatiba) (Solong Pagmamay-ari) DEFENDANT'S HOME ADDRESS: (Pahatirang Sulat sa Bahay ng Hinahabla) (city) _ URDANETA cry 7428 (Lungsod) Zip Code (Province, if applicable)_ PANG AS!IMAN (Lalawigan, kung meron) Zip Code Telephone No. Cellphone No,_ O%324350'3 (Telepono Big} (Selpon Blg.) PLACE OF WORK: URDANETA CIN (Lugar ng Pinagtatrabahuan) Telephone No. Cellphone No. 0% 3243 5013 (Telepono Big.) (Selpon Ble.)2016 Revised Rules of Procedure for Small Claims Cases 19 NAME OF DEFENDANT'S REPRESENTATIVE: ___ NONE if applicable (must be a non-lawyer) (Pangalan ng Kinatawan:) (kung meron) [dapat hindi abogado] HOME ADDRESS: (City) (Pahatirang Sulat sa Bahay) (Lungsod) Zip Code (Province, if applicable), (Lalawigan, kung meron) Zip Code Telephone No. Cellphone No. (Telepono Big.) (Selpon Blg.) PLACE OF WORK: (Lugar ng Pinagtatrabahuan) Telephone No. Cellphone No, (Telepono Big.) (Selpon Blg,) If more than one (1) defendant, list next defendant here: (Kung higit sa isa (1) ang Hinahabla, ilagay ang susunod na hinahabla rito:) NAME OF DEFENDANT/S SEX AGE CIVIL STATUS (Pangalan ng Hinahabla) (Kasarian) (Edad) (Katayuang Sibil) INDIVIDUAL CORPORATION PARTNERSHIP (Tao/Indibidwal) (Korporasyon) (Bakasan) COOPERATIVE SOLE PROPRIETORSHIP (Kooperatiba) (Solong Pagmamay-ari) DEFENDANT'S HOME ADDRESS: (Pahatirang Sulat sa Bahay ng Hinahabla) (City) eS ee (Lungsod) Zip Code20 (Province, if applicable), (Lalawigan, kung meron) Telephone No. (Telepono Big.) PLACE OF WORK: A.M. No. 08-t -SC Zip Code Cellphone No. (Selpon Ble.) (Lugar ng Pinagtatrabahuan) Telephone No. (Telepono Blg.) Cellphone No._ (Selpon Blg.) NAME OF DEFENDANT'S REPRESENTATIVE: if applicable (must be a non-lawyer) (Pangalan ng Kinatawan:) (kung meron) [dapat hindi abogado] HOME ADDRESS: (City) (Pahatirang Sulat sa Bahay) (Lungsod) (Province, if applicable), (Lalawigan, kung meron) Telephone No. (Telepono Big.) PLACE OF WORK: Zip Code Zip Code Cellphone No. (Selpon Blg.) (Lugar ng Pinagtatrabahuan) Telephone No. (Telepono Big.) Cellphone No. (Selpon Ble.) “Note: Ifyou need more space, you can write at the back of this Form. (*Tala: Kung kailangan mo ng karagdagang patlang, maaari mong isulat sa likod ng Form na ito.)2016 Revised Rules of Procedure for Small Claims Cases 21 2 Plaintiff claims the defendant owes him/her/it PLONE HUN TEN) TROUSAND Pesos (PhP \30,000-00) (Ang Hinahabla ay umutang sa Naghahabla ng halagang) (a) Why does the defendant owe plaintiff money? (Bakit ang Hinahabla ay nagkautang ng salapi sa Naghahabla?) THE PLAINTITFE LOANED THE DEPENDANT WITH [Re _CRoMise TO PAY BY A PROM sony NOTE (Ifyou need more space, please use the back page). (Kung kailangan mo ng karagdagang patlang, maaaring gamitin ang likod ng pahinang ito.) (b) When did this happen? (Kailan ito nangyari?) Dates Mem (A, 200 (Petsa) If no specific date, give the time period; (Kung walang tiyak na petsa, ibigay ang tantiyang panahon) Date started: (Petsa nagsimula) Through: (Hanggang) (©) How did you compute the money owed to you? (Do not include court costs or fees) PRINCIPAL AMOUNT IN Te ORoMISOR NOTE (Paano mo kinuwenta ang salaping inutang sa iyo?) [Hindi kasama ang bayad sa pagpapatala sa hukuman.] (a) Did you ask the defendant to pay you before you filed this case? (Siningil mo ba ang Hinahabla bago ka nagsampa ng kasong ito?) {Yes [5 No (Oo) (Hindi) Iino, explain: (Kung hindi, ipaliwana:22 A.M. No. 08-8-7-SC (b) How did you ask the defendant? Paano mo siningil ang Hinahabla?) (1 in person ZBy phone (Sa kanya mismo) (Sa telepono) A Inwriting C others (please specify) (Sa sulat) (Iba pa) [pakisulat kung paano} (©). When did you do this? T sharted Nuguss 1202) whioh is she Cate st payman! shat be mode. (Kailan mo ginawa ito?) 4 What is your proof that defendant owes you money? PROMI soRN Nove (Ano ang iyong katibayan o pruweba na ang Hinahabla ay may utang na salapi sa iyo?) 5. Did you attach your proof to this form? (Iyo bang inilakip ang katibayan o pruweba sa Form na ito?) (Z Yes [No (Oo (Hindi) 6, Was this claim referred to the barangay? (Dumaan ba sa barangay ang paniningil na ito?) Zi Yes No Not Covered (Oo) (Hindi) (Hindi sakop) State reason: (Isulat ang dahilan) Ifyes, do you have a Certificate to File Action or a Compromise Agreement executed before the barangay? (Kung 00, meron ka bang Patunay sa Pagsampa ng Kaso Kasunduan na isinagawa sa barangay?) 6-A, How many small claims cases have you filed within this calendar year prior to this present case, in this court station and in the entire country: (Pang ilang kaso na itong isinampa mo sa loob ng kasalakuyang taon sa korte na ito at sa buong bansa?)2016 Revised Rules of Procedure for Small Claims Cases 23 7. By the filing of this action, plaintiff hereby waives any amount in excess of P200,000.00, excluding interest and costs. (Sa pagsampa ng kasong ito, ang Naghahabla ay isinusuko ang anumang halaga na higit sa P200,000.00, hindi kasama ang tubo at gastos sa pagsampa ng kasong ito.) PRAYER (PAGSAMO) WHEREFORE, plaintiff respectfully prays for judgment ordering defen- dant to pay the amount of P _\3O, 00-09 with interest at the rate of G_% per annum/per month from _AJGUST 10), 2021 _ until fully paid. (DAHIL DITO, ang Naghahabla ay magalang na sumasamo na igawad ang kapasiyahang utusan ang Hinahabla na magbayad sa Naghahabla ng halagang =P. pati ang tubo na % bawat taon! buwan simula _ hanggang ganap 0 lubos na mabayaran ito.) ; 20. MARIO RED FOR OFFICIAL USE ONLY PLAINTIFF (Pare se" Opisyal na gamit lamang) To be accomplished by the Branch Clerk of (Naghahabla) Coun (Sasagutan ng Kawani ng Hukuman) 1. Cause of action (1 Cheek (] Promissory Note C1 Contract Dlorat — C written (0 Barangay Agreement Clothers (Please specify): 2 Barangay conciliation required. if yes, Certificate to File Action Compromise Agreement attached. Barangay conciliation not required. Please slate the reason):24 A.M. No. 08-8-7-SC FORM 1-A-SCC VERIFICATION AND CERTIFICATIONAGAINST NON-FORUM SHOPPING SPLITTINGA SINGLE CAUSE OF ACTION AND MULTIPLICITY OF SUITS 1_Ma&RI0_ RED of legal age, FILIPINO CITIZEN (name) (citizenshi ip) SINGE , and a resident of URDANETA CIN : (civil status) (residence) on oath, state: 1. That Tam the OLAINTIFE in the above-entitled case have caused this_STRIEMENT OF CLNM to be prepared; that I read and understood its contents which are true and correct of my own personal knowledge and/or based on true records; 2. That I have not commenced any action or proceeding involving the same issue or subject matter, and specifically the same check/s in the Supreme Court, the Court of Appeals or any other tribunal or agency, particularly before the Office of the City Prosecutor of _ \IRONNETA CITY ; that to the best of my 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 should learn thereafter that a similar action or proceeding has been filed or is pending before these courts or tribunal or agency, I undertake to report that fact to the Court within five (5) days therefrom. 3. That the filing of this case is not in violation of the rule against splitting a single cause of action or multiplicity of suits, 4, That knowingly and voluntarily waive and forego the institution of any criminal complaint for Violation of Batas Pambansa Blg. 22 against the defendant herein based on the same check/s subject matter of this Small Claims Complaint.2016 Revised Rules of Procedure for Small Claims Cases 25 IN WITNESS WHEREOF, I have hereunto set my hand this day of SEPTEMBER, 20 21 Affiant 4 SUBSCRIBED AND SWORN to before me this 9 D day of SEPTEMBER, 20_21 SZ J0sé RIZAL NOTARY PUBLICREPUBLIC OF THE PHILIPPINES CITY OF URDANETA BARANGAY STO. DOMINGO OFFICE OF THE LUPON TAGAPAMAYAPA Barangay Case No. 21 MARIO RED For: Collection Complainant, -versus- LUIGI GREEN Respondent. CERTIFICATE TO FILE ACTION This is to Certify that: 1. There has been a personal confrontation between the parties before the Punong Barangay and that the mediation failed. 2. The Pangkat Tagapagkasundo was constituted and there has been a personal confrontation between the parties before the Pangkat likewise, did not result into a settlement. 3. Therefore, the corresponding complaint for the said dispute may now be filed in appropriate Court or any Government Office. Issued this 4° day of September, 2021 at Urdaneta City, Pangasinan. Be Cruz Pangkat Secretary Noted by: andi cio Lupong ChairpersonPROMISSORY NOTE I LUIGI GREEN, of legal age, Filipino and resident of Brgy. Sto Domingo, Urdaneta City, Pangasinan, hereby acknowledge to have received from MARIO RED the total amount of One Hundred Thirty Thousand Pesos (P130, 000.00) this 19" day of April 2021 with the promise that I will return the said amount on or before August 19, 2021 without the necessity of demand. 19" day of April, 2021 at Sto Domingo, Urdaneta City, Pangasinan. LUIGI GREEN38 A.M. No. 08-8-7-SC FORM 7-SCC SPECIAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: 1 MARIO REO . of legal age. single: married, with residence at _ STO. COMING URDANETA CTY do hereby appoint, name and constitute MASK LESTER Bas: _ likewise of legal age, single/married, with residence at SY COMIN _URDANETA CITY . who is related to me andor is my next- of-kin, and is not a lawyer, as my true and legal representative ta act for and in my name and stead and to represent me during the hearing of Crvil Case No. {2- 2024 to enter into amicable setlement, to submit to alternative modes of dispute resolution and to make admissions or stipulations of facts and documents without further consultation trom me Uhereby grant my representative full power and authority to execute and perform every act necessary to render effective the power to compromise as though | myself have so performed it and hereby approving all that he may do by virtue of these presents. tin 19 day In witness whereof. | hereunto set my hand this of SEPTEMBES 20 21 a URDANETA CONT (26. Principal — ; joa Agent EISLEN KS, LLA -GARCIA secant tence Witnesses: (ACKNOWLEDGMENT)28 A.M. No. 08-8-7-SC FORM3-SCC REPUBLIC OF THE PHILIPPINES MUNICIPAL TRIAL Couet IN CITIES Hist {uO CORT CIN oF URDENETA MaBi0 RED : ~~ Plaintiff, vs. Civil Case No. __12- 2024 For: COURCTION OF SUM OF MONEY LUict. GREEN Defendant. Xe eec een eeec een eece sero etc eees x RESPONSE (SAGOT) Defendant/s _state/s: (Ang Hinahabla ay nagsasaad:) 1. Defendant denies the Statement of Claim for any of the following reasons: (Put a check in any of the following) (Tinatanggihan ng Hinahabla ang Habla ng Pagsingil sa alinmang sumusunod na dahilan): [Pumili sa mga sumusunod at lagyan ng tsek] (a) ____ Defendant does not owe plaintiff any money. (Ang Hinahabla ay walang pagkakautang na salapi sa Wi Naghahabla.) Defendant owes plaintiff only a portion of the amount claimed. (Ang utang ng Hinahabla ay bahagi lamang ng halagang sinisingil ng Naghahabla.)2016 Revised Rules of Procedure for Small Claims Cases 29 It is the plaintiff who owes defendant money. (Ang Naghahabla ang siyang may utang na salapi sa Hinahabla,) (b) Ifdefendant owes plaintiff only a portion of the amount claimed, how much is this? (Kung ang wang ng Hinahabla ay bahagi lamang ng halagang sinisingil ng Naghahabla, magkano ito?) TRE DEFENDANT ONLY denis # 120,000.00 TO TRE PLAINTIFE t (c) If it is the plaintiff who owes defendant money, how much and when did this happen? (Kung ang Naghahabla ang siyang may utang na salapi sa Hinahabla, magkano at kailan ito nangyari?) If no specific date, estimate the time period: (Kung walang tiyak na petsa, ibigay ang tantiyang panahon) Date started (Petsa nagsimula) Through, (Hanggang) (d) How did you compute the money owed you? (Do not include court costs or fees for service.) (Paano mo kinuwenta ang salaping pagkakautang sa iyo?) (Huwag isama ang filing fees at bayad sa serbisyo.) 2. If plaintiff owes you money, did you ask plaintiff to pay you? (Kung ang Naghahabla ay siyang may pagkakautang sa iyo, siningil mo ba siya?) Yes No (Oo) (Hindi) If yes, how? (Kung 00, paano?)30 A.M. No. 08-8-7-SC _____ Im person ___ Others (specify) (Sa kanya mismo) (Iba pa) [ano ito?] _____Inwriting (Sa sulat) ____ By phone (Sa telepono) 3. Do you have any proof? / Yes No (Meron ka bang anumang katibayan?) (Oo) (Hindi) What is this proof? Z_ Receipt (Anong katibayan ito?) Resibo) Other document (Iba pang dokumento) Witness (Saksi/testigo) 4, As the Statement of Claim is baseless, defendant is entitled to the following counterclaims: (Sa dahilang walang basehan ang Habla ng Pagsingil, ang Hinahabla ay may karapatan sa mga ganting-habol na sumusunod) Actual Damages for the value of the loss suffered by the filing of the case P . . (Bayad para sa aktwal na pinsalang idinulot ng pagsampa ng kaso) Costs of suit for the money defendant spent in filing a countercharge against plaintiff P . (Kabayaran/Gasios sa kasong isinampa) a aus DEFENDANT (Hinahabla)ACKNOWLEDGEMENT RECEIPT This is to acknowledge the receipt of ten thousand pesos (10,000.00) Philippine Currency from LUIGI GREEN as partial payment of the total amount of One Hundred Thirty Thousand Pesos (130,000.00) for the loan borrowed. Urdaneta City, Pangasinan, this 25" day of April, 2021 ve REDREPUBLIC OF THE PHILIPPINES MUNICIPAL TRIAL COURT IN CITIES 1* JUDICIAL REGION URDANETA CITY MARIO RED Plaintiff, CIVIL CASE NO. 12- 2021 -versus- LUIGI GREEN, Defendant. DECISION This is a small claims action for collection of sum of money filed by the plaintiff against the defendant. Plaintiff alleged that both he and defendant are residents of Sto. Domingo, Urdaneta City, Pangasinan. He further alleged that the defendant borrowed money from him last 19 April 2021 in the amount of One Hundred Thirty Thousand Pesos (PhP 130,000. 00), as evidence by the Promissory Note signed by the Defendant dated 19 April 2021. For one reason and another, defendant was not able to pay his indebtedness; thus, the plaintiff was constrained to file this case. The issue to be resolved by this Court is whether or not the defendant is liable to pay the plaintiff the amount of One Hundred Thirty Thousand pesos (PhP 130,000.00). During the hearing conducted today, the defendant admitted having received the said money. The defendant also admitted having signed the computerized Promissory note dated 19 April 2021. On theother hand, plaintiff admitted having received the amount of Ten Thousand Pesos (PhP 10,000.00) as partial Payment of the said loan. Plaintiff evidence consist of Computerized Promissory Note signed by the defendant dated 19 April 2021, and Certification to File Action dated 04 September 2021. This Court finds that the claim of the plaintiff s meritorious. The law provides that a contract shall be in any form and whenever there is perfection of contract, the same must be complied with in good faith by both of the parties. Here, the evidence presented by the plaintiff is sufficient to establish that there is a contract of loan between the plaintiff and the defendant. Moreover, this Court will take judicial notice of the admission made by the parties and the same shall be considered in resolving the issues at hand for the act, declaration, or omission of a party as to a relevant fact may be given in evidence against him or her. The hearing conducted today, the defendant's admission is evidence against him and in the same manner, the admission made by the plaintiff shall also be taken against him. As it stands clear, the remaining obligation of the defendant now will be One Hundred Twenty Thousand Pesos (PhP 120,000.00). Thus, since defendant utterly failed to comply and honor his obligation; thus, leaving no recourse for the plaintiff but to initiate this action, justice and law dictate that the defendant must pay her indebtedness that he owes to the plaintiff and in addition thereto, he is also liable to pay interest in the amount of six (6%) percent per annum computed from the day this case was filed until full payment thereof. WHEREFORE, premises considered, the claim of the plaintiff is hereby granted. This Court orders the defendant, Luigi Green, to pay the plaintiff, Mario Red, the amount of One Hundred Twenty Thousand pesos (PhP 120,000.00) as payment for the remaining balance of the loan, plus interest at the rate of six (6%) percent per annum computed from the time this case was filed until the same is full paid.SO ORDERED. Given this 7" day of October 2021 at Urdaneta City, Pangasinan, Philippines. ont PEACH Presiding Judge