Professional Documents
Culture Documents
Small Claims
Small Claims
Small Claims
Plaintiff,
- versus -
MAE B. LORDAN,
Defendant.
x------------------------------------x
STATEMENT OF CLAIM
(HABLA NG PAGSINGIL)
1.
RUTH T. BALLEBAR
NAME OF PLAINTIFF/S
Female
SEX
30
AGE
(kasarian) (Edad)
(Pangalan ng Naghahabla)
Single
CIVIL STATUS
(katayuang Sibil)
__ INDIVIDUAL
___ CORPORATION
(tao/indibidual)
(korporasyon)
___ PARTNERSHIP
(bakasan)
___ COOPERATIVE
(kooperatiba)
(solong Pagmamay-ari)
4430
Zip Code
_____
Zip Code
Telephone No.____________
(Telepono blg.)
(Selpon Blg.)
1
PLACE OF WORK___________________________________________
(Lugar ng Pinagtatrabahuhan)
MAE B. LORDAN
NAME OF DEFENDANT/S
Female
SEX
(Pangalan ng Hinahabla)
(kasarian)
__ INDIVIDUAL
(tao/indibidual)
33
AGE
(Edad)
Married
CIVIL STATUS
(Katayuang Sibil)
___ CORPORATION
(korporasyon)
___ PARTNERSHIP
(bakasan)
___ COOPERATIVE
(kooperatiba)
(solong Pagmamay-ari)
4430
Zip Code
(Telepono blg.)
(Selpon Blg.)
PLACE OF WORK___________________________________________
(Lugar ng Pinagtatrabahuhan)
__________________________
_________
Zip Code
(Telepono blg.)
(Selpon Blg)
PLACE OF WORK___________________________________________
(Lugar ng Pinagtatrabahuhan)
Telephone No._______
(Telepono blg.)
(Selpon Blg)
(a)
1. Cause of action
__ Check
__ Promissory note
__ Contract
___ oral __ written
__ Barangay Agreement
___ Injuries
__ Accidental ___ intentional
__ Damage to Property
__ other (Please Specify
______________________
______________________________
______________________________
______________________________
(b)
(Petsa)
___________________________________
___________________________________
How did you compute the money owed to you?(Do not include court
Costs or fees_____________________________________________
_______________________________________________________
_______________________________________________________
(Paano mo kinuwenta ang salaping inutang sa iyo? (Hindi kasama
3.(a) Did you ask the defendant to pay you before you filed this case?
(siningil mo ba ang hinahabla bago ka nagsampa ng kasong ito?)
___________ Yes
_______ No.
(oo)
(Hindi)
If no, explain:______________________________________
(Kung hindi, ipaliwanag)
(b)
(c)
4.
_____ by Phone
(Sa Telepono)
_____ others (Please specify
(iba pa) (pakisulat kung
paano
6.
___________ No
(hindi)
_____ No
(hindi)
In this court station, how many small claims cases have you
filed within this calendar year prior to this present case?
_______
4
PRAYER
(PAGSAMO)
WHEREFORE, plaintiff respectfully prays for judgment, ordering
defendant to pay the amount of SIXTY THOUSAND PESOS
(Php.
60,000.00) with interest at the rate of ____% per annum /per month from
_________________ until fully paid.
(Dahil dito, ang Naghahabla ay magalang na sumasamo na igawad
RUTH T. BALLEBAR
PLAINTIFF
(Naghahabla)