Republic of the Philippines

12th Judicial Region

Regional Trial Court
Branch 123

MR. ABCDE CIVIL CASE NO. __________

Plaintiff,

-versus- FOR

MR. WXYZ COLLECTION OF SUM OF MONEY

Defendant.
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COMPLAINT

The undersigned respectfully avers the following:

1. That the undersigned is of legal age, married and a resident of No.008,

1234567, Kalawakan City, where he may be served with the Court’s notices,
order, summons and other processes;

2. That the undersigned complainant is the sole proprietor of 12345 Merchandise

which is located in No.001, 1234567890, Kalawakan City;

3. That on December 1, 2021, plaintiff and defendant entered into an agreement

in writing, a copy of which is hereto annexed as Annex A;

4. That in accordance with the provisions of said agreement respondent received

several goods from the plaintiff’s store and promised to pay the same on or
before July 1, 2022;

5. That Defendant, after repeated demands made by Plaintiff, as evidence by

herein attached demand letters, failed to pay the amount of P5,000,000. The said
amount being due and demandable;

6. That plaintiff, by reason of defendant’s none payment suffered losses

amounting to 100,000.00 and compelled to seek the service of an attorney for
50,000; and

7. That I am executing this complaint to collect the amount of P5,000,000.00,

damages amounting to 100,000.00, attorney’s fees, and other exemplary and
moral damages.
 PRAYER

WHEREFORE, considering the foregoing premises, the undersigned respectfully prays

that P5,000,000.00, damages amounting to 100,000.00, attorney’s fees, and other
exemplary and moral damages be awarded to herein plaintiff.

Other relief and remedies equitable within the premises are also prayed for.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 15th day of

November 2022, at Kalawakan City, Philippines.

MR. ABCDE
Plaintiff

SUBSCRIBED AND SWORN TO BEFORE ME this 15th day of November 2022, at

Kalawakan City, Philippines.

Doc. No._______
Page No._______
Book No._______
Series of 2022.

Republic of the Philippines )

City of Cotabato )
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VERIFICATION AND CERTIFICATION

OF NON-FORUM SHOPPING

I, MR. ABCDE, of legal age, married and a resident of No.008, 1234567, Kalawakan
City, under oath states that:

1. That I am the plaintiff in above-cited case;

2. That I have caused the preparation and filing of this complaint;
3. That I have read and understood the contents thereof and I know them to be true
and correct of my own personal knowledge; and
4. That I further certify that I have not commenced any other action or proceeding
involving the same parties and the same causes of action in the Supreme Court,
the Court of Appeals or any other tribunal or agency; that to the best of my
knowledge, no other action or proceeding involving the same parties and the
same causes of action has been filed or is pending in the Supreme Court, the
Court of Appeals or any other tribunal or agency, and if we should learn that a
similar action or proceeding has been filed or is pending in the Supreme Court,
 the Court of Appeals or any other tribunal or agency, I hereby undertake to
inform this Honorable Body of that fact within five (5) days from notice thereof;

IN WITNESS WHEREOF, I have hereunto affixed my signature this 15th day of

November 2022, at Kalawakan City, Philippines

ABCD
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 15th day of November 2022, at

Kalawakan City, Philippines.

Doc. No._______
Page No._______
Book No._______
Series of 2022