REPUBLIKA NG PILIPINAS . . . . .

)
LUNGSOD NG QUEZON . . . . . . ) S.S
x-------------x

SINUMPAANG SALAYSAY - REKLAMO

Ako si __________________________________ , nasa hustong gulang, may-

asawa/binata/dalaga,(hanap-buhay)_________________________________________at
kasalukuyan nakatira sa_____________________________________, matapos
makapanumpa ng naayon sa ating saligang batas ay kusang loob na nagsasaad ng mga
sumusunod;

Na, ako ang pormal na magrereklamo laban kay/kina

_____________________________________________________________
nakatalaga sa___________________________________________________;

Na, ______________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Na, kalakip ng sinumpaang salaysay na ito ay ang

_________________________________________________________________;

Na, ang lahat ng sinabi ko sa salaysay na ito ay pawang katotohan

lamang at walang sinumang nagturo o nag impluwensiya at alam ko rin na
maaaring gamitin laban sa akin sa alinmang hukuman ng Pilipinas oras na
mapatunayang ako ay nagsisinungaling.

Bilang patotoo ng sinumpaang salaysay na ito ay aking nilagdaan

ngayong ika - ____ ng _________ 201__, dito sa Kampo Crame, Lungsod Quezon.

___________
Nagsalaysay

NILAGDAAN AT SINUMPAAN sa aking harapan ngayong ika – ___ ng

_________ 201___, dito sa Kampo Crame, Lungsod ng Quezon.

_____________________
Administering Officer
REPUBLIKA NG PILIPINAS . . . . .)
LUNGSOD NG QUEZON . . . . . . ) S.S
x-------------x

SINUMPAANG SALAYSAY

Ako si __________________________________ , nasa hustong gulang, may-

asawa/binata/dalaga,(hanap-buhay)________________________________________ at
kasalukuyan nakatira sa_____________________________________, matapos
makapanumpa ng naayon sa ating saligang batas ay kusang loob na nagsasaad ng mga
sumusunod;

Na, ______________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Na, ang lahat ng sinabi ko sa salaysay na ito ay pawang katotohan

lamang at walang sinumang nagturo o nag impluwensiya at alam ko rin na
maaaring gamitin laban sa akin sa alinmang hukuman ng Pilipinas oras na
mapatunayang ako ay nagsisinungaling.

Bilang patotoo ng sinumpaang salaysay na ito ay aking nilagdaan

ngayong ika - ____ ng _________ 201__, dito sa Kampo Crame, Lungsod Quezon.

__________
Nagsalaysay

NILAGDAAN AT SINUMPAAN sa aking harapan ngayong ika – ___ ng

_______________ 201___, dito sa Kampo Crame, Lungsod ng Quezon.

____________________
Administering Officer
REPUBLIKA NG PILIPINAS . . . . .)
LUNGSOD NG QUEZON . . . . . . ) S.S
x-------------x

KARAGDAGANG SINUMPAANG SALAYSAY - REKLAMO

Ako si __________________________________ , nasa hustong gulang, may-

asawa/binata/dalaga,(hanap-buhay)_________________________________________at
kasalukuyan nakatira sa_____________________________________, matapos
makapanumpa ng naayon sa ating saligang batas ay kusang loob na nagsasaad ng mga
sumusunod;

Na, ako ang nagreklamo laban kay _______________________ nakatalaga

sa___________________________________________________;

Na, ______________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Na, ang lahat ng sinabi ko sa salaysay na ito ay pawang katotohan

lamang at walang sinumang nagturo o nag impluwensiya at alam ko rin na
maaaring gamitin laban sa akin sa alinmang hukuman ng Pilipinas oras na
mapatunayang ako ay nagsisinungaling.

Bilang patotoo ng karagdagang sinumpaang salaysay na ito ay

aking nilagdaan ngayong ika - ____ ng _________ 20__, dito sa Kampo Crame,
Lungsod Quezon.

___________
Nagsalaysay

NILAGDAAN AT SINUMPAAN sa aking harapan ngayong ika – ___ ng

_________ 20___, dito sa Kampo Crame, Lungsod ng Quezon.

_____________________
Administering Officer
REPUBLIKA NG PILIPINAS . . . . .)
LUNGSOD NG QUEZON . . . . . . ) S.S
x-------------x

PINAGSAMANG SINUMPAANG SALAYSAY - REKLAMO

kami sina ______________________at__________________________ , nasa

hustonggulang,may-asawa/binata/dalaga,(hanapbuhay)_________________________at
kasalukuyan nakatira
sa____________________________________________________, matapos
makapanumpa ng naayon sa ating saligang batas ay kusang loob na nagsasaad ng mga
sumusunod;

Na, kami ang pormal na magrereklamo laban kay/kina__________________

_________________________________________________________,
Nakatalaga sa
____________________________________________________________

Na, ______________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Na, ang lahat ng sinabi namin sa salaysay na ito ay pawang katotohan

lamang at walang sinumang nagturo o nag impluwensiya at alam rin naming na
maaaring gamitin laban sa amin sa alinmang hukuman ng Pilipinas oras na
mapatunayang kami ay nagsisinungaling.

Bilang patotoo ng pinagsamang sinumpaang salaysay na ito ay

aming nilagdaan ngayong ika - ____ ng _________ 20__, dito sa Kampo Crame,
Lungsod Quezon.

___________ ___________
Nagsalaysay Nagsalaysay

NILAGDAAN AT SINUMPAAN sa aking harapan ngayong ika – ___ ng

_________ 20___, dito sa Kampo Crame, Lungsod ng Quezon.

_____________________
Administering Officer
REPUBLIKA NG PILIPINAS . . . . .)
LUNGSOD NG QUEZON . . . . . . ) S.S
x-------------x

PINAGSAMANG SINUMPAANG SALAYSAY

kami sina __________________________________________________ , nasa

hustong gulang, may-asawa/binata/dalaga,(hanapbuhay)_______________________at
kasalukuyan nakatira
sa____________________________________________________, matapos
makapanumpa ng naayon sa ating saligang batas ay kusang loob na nagsasaad ng mga
sumusunod;

Na, ______________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Na, ang lahat ng sinabi namin sa salaysay na ito ay pawang katotohan

lamang at walang sinumang nagturo o nag impluwensiya at alam rin naming na
maaaring gamitin laban sa amin sa alinmang hukuman ng Pilipinas oras na
mapatunayang kami ay nagsisinungaling.

Bilang patotoo ng pinagsamang sinumpaang salaysay na ito ay

aming nilagdaan ngayong ika - ____ ng _________ 20__, dito sa Kampo Crame,
Lungsod Quezon.

___________ __________ __________

Nagsalaysay Nagsalaysay Nagsalaysay

NILAGDAAN AT SINUMPAAN sa aking harapan ngayong ika – ___ ng

_________ 20___, dito sa Kampo Crame, Lungsod ng Quezon.

_____________________
Administering Officer
REPUBLIKA NG PILIPINAS . . . . .)
LUNGSOD NG QUEZON . . . . . . ) S.S
x-------------x

KARAGDAGANG SINUMPAANG SALAYSAY

Ako si __________________________________ , nasa hustong gulang, may-

asawa/binata/dalaga,(hanap-buhay)_________________________________________at
kasalukuyan nakatira sa_____________________________________, matapos
makapanumpa ng naayon sa ating saligang batas ay kusang loob na nagsasaad ng mga
sumusunod;

Na, ______________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Na, ang lahat ng sinabi ko sa salaysay na ito ay pawang katotohan

lamang at walang sinumang nagturo o nag impluwensiya at alam ko rin na
maaaring gamitin laban sa akin sa alinmang hukuman ng Pilipinas oras na
mapatunayang ako ay nagsisinungaling.

Bilang patotoo ng karagdagang sinumpaang salaysay na ito ay

aking nilagdaan ngayong ika - ____ ng _________ 20__, dito sa Kampo Crame,
Lungsod Quezon.

___________
Nagsalaysay

NILAGDAAN AT SINUMPAAN sa aking harapan ngayong ika – ___ ng

_________ 20___, dito sa Kampo Crame, Lungsod ng Quezon.

_____________________
Administering Officer