REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

NATIONAL CAPITAL JUDICIAL REGION
BRANCH XXX
CITY OF SAN FERNANDO, PAMPANGA
(rtc1sfp042@judiciary.gov.ph)

IN RE: IN THE MATTER OF

THE PETITION FOR
LIQUIDATION (Copy
Caption), COMM. CASE NO. XXX
FOR: VOLUNTARY
(NAME OF COMPANY),
LIQUIDATION
Petitioner.
x----------------------------------------x

NOTICE OF CLAIM

To: MR. BOY SANTOS

Liquidator
Address: c/o The Branch Clerk of Court
Regional Trial Court, Branch 42
San Fernando, Pampanga

Claimant ABC CORPORATION, by counsel, respectfully files the

foregoing Notice of Claim, and states that:
1. ABC Corporation (the “ABC”) is a domestic corporation
engaged in the manufacture and supply of grain products. It has its
principal place of business at No. 98 Canumay East, Valenzuela City.
A copy of ABC’s Certificate of Incorporation bearing Company
Registration No. CS2010XXXX is attached hereto as Annex “A”.
2. Petitioner, which operated its food business under the name
and style “(Name of Restaurant”), used to be the customer of ABC for
the supply of grains since 2015.
3. Petitioner was granted a credit term of thirty (30) days from
delivery to pay the purchased products. The pricing of the products
changed and negotiated from time to time.
Attached as Annexes “B”, “B-1” and “B-2” are the quotations
showing the concessions given to petitioner including the agreed credit
term.
4. Since September 2018 until March 2020, petitioner made ten
(10) purchases from ABC in the total amount of One Million Pesos
(Php1,000,000.00) which remain unpaid to date.
5. The purchases with the amounts due are summarized below.
 1% Total
Invoice and No of
Invoice Value Date Due/ Interest per Amount with
Delivery Invoice PO Number days
in Php 30 days month Interest
Date past due
in Php in Php

2/15/2019 64502 2822 x 3/17/2019 x x x

6/22/2019 67573 4664 x 7/22/2019 x x x
6/24/2019 67615 4786 x 7/24/2019 x x x
7/30/2019 68881 5506 x 8/29/2019 x x x
12/26/2019 73102 651 x 1/25/2020 x x x
12/27/2019 73134 652 x 1/26/2020 x x x
12/28/2019 73177 653 x 1/27/2020 x x x
1/2/2020 73224 654 x 2/1/2020 x x x
1/3/2020 73278 655 x 2/2/2020 x x x
1/4/2020 73311 656/1015/1014 2/3/2020 x x x

Total in Php 850,000.00 50,000.00 1,000,000

The Statement of Account as of July 8, 2021 with the supporting

sales invoices and delivery receipts are attached and marked as
Annexes “C” to “C-9”.
6. The unpaid obligations of the petitioner to ABC have long
become overdue and are demandable.
7. Despite the repeated demands, petitioner failed to pay its
outstanding obligations to ABC.
PRAYER
WHEREFORE, it respectfully prayed that the foregoing Notice of
Claim be admitted/allowed in the above-captioned case, and that ABC be
paid that amount of One Million Pesos (Php1,000,000) representing the
unpaid obligations of petitioners from March 17, 2019 until February 3,
2020, including interest.
Quezon City for San Fernando, Pampanga, July 12, 2021.

NAME
Attorney’s Roll No.
Life Member Roll No. XXXX/Date/Chapter
PTR No. XXXX/Date/Place
MCLE Compliance IV-XXXX/Date

Counsel for Claimant

ABC CORPORATION
Address of Counsel
Mobile No. (09XX) XXX-XXXX
Email: XXXXXXX

STIFICATION OF SERVICE
 The undersigned counsel
Republic of the Philippines  S.S.
Quezon City

VERIFICATION/CERTIFICATION
AGAINST FORUM-SHOPPING

I, XXXXXX, of legal age, Filipino, under oath, depose and state

that I am the Finance Officer of Claimant ABC Corporation; I caused the
preparation of the foregoing Notice of Claim; I read the Notice of Claim
and the contents of which are true and correct based on my own
personal knowledge and authentic records; I attest that the supporting
documents of this Notice Claim are faithful reproduction of its originals;
the Notice of Claim is not filed to harass, cause unnecessary delay, or
needlessly increase the cost of litigation; and the factual allegations
therein have evidentiary support or, if specifically so identified, will
likewise have evidentiary support after a reasonable opportunity for
discovery.

I have not commenced any action involving the same issues in any
case before the Supreme Court, the Court of Appeals, or any other
tribunal or any other government agency, and to the best of my
knowledge, no such other action or claim is pending therein’ and should I
discover that the same or similar action, claim or proceeding is filed or is
pending, I undertake to report such fact to this Honorable Court within
five (5) calendar days from notice

IN WITNESS WHEREOF, I have hereunto affixed my signature this

July 12, 2021 in Quezon City.

XXXXXXXXX
Affiant

SUBSCRIBED AND SWORN TO before me this July 12, 2021, affiant

exhibited to me her Philhealth ID No. XXXXXXXXXXXX as competent
evidence of identity.

WITNESS MY HAND and SEAL on the date and place above-written.

Doc. No. 209;

Page No. 43;
Book No. IV;
Series of 2021.