PETITION FOR VOLUNTARY INSOLVENCY

(Caption and Petition)

PETITION

Petitioner through the undersigned attorney, and unto this Honorable Court, respectfully
alleges:

1. That he is a merchant engaged in the business of ___________________ and has

his principal place of business in said _____________________ for the last ___ years, within the
jurisdiction of this Honorable Court;

2. That he owes debts exceeding in amount the sum of One Thousand pesos which
he is unable to pay in full;

3. That he is willing to surrender all his property, estate, and effects not exempt from
execution for the benefit of his creditors;

4. That attached hereto and made integral parts of this petition are: Schedule “A”
which contains a full and true statement of all his debts and liabilities and a list of the creditors to
whom said debts and liabilities are due; and Inventory “B” which contains an accurate
description of all his property, estate, and effects, and credits in his favor.

(Venue, date, signature)

(Verification, Certification of Non-Forum Shopping)