FORM NO.

102
Petition for Insolvency — Petitioner corporation has no more assets or property to
pay his obligations and had already closed operations.

REPUBLIC OF THE PHILIPPINES

NATIONAL CAPITAL JUDICIAL REGION
REGIONAL TRIAL COURT
BRANCH

IN THE MATTER OF THE PETITION

FOR DECLARATION OF INSOLVENCY.
SP. CASE NO.

__________________,

Petitioner,

X ---------------------------X

PETITION
PETITIONER by counsel, to this Honorable Court, respectfully states,
that:
1. Petitioner is a domestic corporation duly organized and existing
under Philippine laws, with principal office at __________________________ . It
may be served with court processes and orders of this Honorable Court, and
pleadings through its counsel, ________________________________, a
_______________________;

2. Petitioner is filing this petition under Section 12 of Republic Act No.

10142, otherwise known as the "Financial Rehabilitation and Insolvency Act
[FRIA] of 2010, to declare it Insolvent considering that it has no sufficient assets,
cash or property, to pay its outstanding obligations now or hereafter.

3. That due to continued losses it has incurred starting

_____________________ which resulted in its operation at a loss; thus, it was not able
to pay its obligations as they fall due; the salaries of its employees were not paid
on time, and its tax liabilities remain unpaid; petitioner was constrained to cease
and totally stopped and closed its operations as of ______________________.
Photocopies of the Secretary's Certificate on the total closure of petitioner's
operation is attached as Annex "A";

4. As of the filing of this Petition, petitioner is not aware of any pending

action or proceedings initiated by any person, private or government firm or
agency, against it.

5. To its knowledge, petitioner's existing obligation amounts to

______________________________________, as listed in the Inventory of
Liabilities as Annex _____;

6. Petitioner does not pray for a suspension of payment nor propose

any mode of payment of its aforesaid liabilities because it has no means,
property or asset or cash, or financial capacity to pay or offer to pay the same
because it has no asset, cash or property, or financial capacity to offer payment;

7. In compliance with the Rules, attached are the Audited Financial

Statements for the years __________ and _____________ as Annexes ______;

8. The petitioner prays for the issuance of a Stay Order against any and
all claims, of whatever nature and kind, that any person, private or government
agency, firm, corporation or entity may have against herein petitioner;

9. Considering that the petitioner had ceased and closed operation as

early as ___________, and that it has no assets for liquidation and distribution to
its creditors, hence, the appointment of a Liquidator is no longer necessary.

PRAYER
WHEREFORE, it is respectfully prayed of this Honorable Court, that:
1. Upon filing of this Petition:
a. Consider this Petition for Declaration of Voluntary Insolvency;
b. Issue a -stay Order under such terms under RA 10142 (FRIA) Law of
2010 restraining all claims or demands of whatever nature or character, (either
existing or which may thereafter be discovered) against the petitioner;
c. Upon due completion of notice to its creditors and publication of this
petition, set creditor's conference or initial hearing;
2. After appropriate proceedings:
a. Issue an Order declaring petitioner an insolvent debtor;
Other reliefs just and equitable are likewise prayed for _______, for
______________, (date)

Counsel for the Plaintiff

VERIFICATION AND CERTIFICATION

AGAINST FORUM SHOPPING

JURAT
(Signature and Seal of the Notary Public)
(FORM NO. 1)