PETITION FOR REVIEW ON CERTIORARI

(Caption and Title)

PETITION FOR REVIEW

PETITIONER in the above-entitled case, and unto this Honorable Court,

respectfully avers:

1. That the petitioner is ___________; that the respondent is

2. That the following, in brief, are facts of this case:

SUMMARY STATEMENT OF FACTS

(Here give a summary statement of the matters involved, in numbered

paragraphs, attaching copies of such matters necessary in the determination o f the legal
issues to be raised, each copy being marked as Annex “A,” etc.)

3. The following assignments of errors had been made in the Court of

Appeals, to wit: _____________________________________;

4. That there are special and important reasons consisting mainly of

questions of law justifying a review by this Honorable Supreme Court of the decision of
the respondent Court of Appeals (or the Regional Trial Court, etc., as the case may be).
Among said reasons are the following:

REASONS FOR ALLOWANCE OF WRIT

(1) (Here raise only questions of law

(2) which must be distinctly set

(3) forth)

5. That attached to this petition is a certified copy of the decision of the

Court of Appeals (or the RTC, etc., as the case may be) herein sought to be reviewed,
marked “Annex____” together with twenty (20) printed copies of the record of appeal.

PRAYER

WHEREFORE, it is respectfully prayed that this petition for review on writ of

certiorari be granted.

(Venue, date, signature)

(Verification)