Republic of the Philippines
[Name of the Court]
[City or Municipality]
[Branch No.]
**[Your Name]**
[Address]
[Contact No./Email]
Plaintiff,
– versus –
**[Name of Debtor/Defendant]**
[Address]
[Contact No./Email]
Defendant.
S.C. Case No. ________
For: Collection of Sum of Money
(Non-Payment of Promissory Note)
STATEMENT OF CLAIM
I, [Your Name], of legal age, Filipino, residing at [Your Address], respectfully state:
1. The Defendant, [Name of Debtor], executed a Promissory Note on [Date], promising to
pay me the amount of ₱[Amount] on or before [Due Date].
2. Despite repeated demands, the Defendant has failed and refused to pay the amount due,
which remains unpaid to this date.
3. I have already sent a demand letter dated [Date], but the Defendant failed to settle
his/her obligation.
4. The total amount being claimed is ₱[Principal], with no interest (or with interest, if
agreed upon in writing).
5. This claim does not exceed ₱1,000,000, exclusive of interest and costs.
6. I am executing this claim in good faith, and I am willing to appear before the Court and
comply with its procedures.
PRAYER:
WHEREFORE, I respectfully pray that judgment be rendered in my favor and that the
Defendant be ordered to pay the amount of ₱[Amount], plus any lawful interest and costs of
the suit.
I am also submitting the required Certification Against Forum Shopping and Supportive
Documents.
[Signature]
[Your Full Name]
Plaintiff
Attachments:
- Copy of the Promissory Note
- Copy of Demand Letter (with proof of sending)
- Any receipts or proof of loan
- Valid government ID