REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT

NATIONAL CAPITAL JUDICIAL REGION
BRANCH 107, QUEZON CITY

ABC
Plaintiff,
-versus-

CIVIL CASE NO. 2016

1007
FOR COLLECTION OF SUM
OF MONEY
123
Defendant
x---------------------x

COMPLAINT

COMES NOW the Plaintiff, by counsel, unto this Honorable

Court, STATES that:

1. That plaintiff ABC is of legal age, single, Filipino citizen, and a

resident of No.17 Adrian Street, North Fairview, Quezon City.
2. That defendant 123 is likewise of legal age, single, Filipino citizen,
and a resident of No. 16 Burbank Street, North Fairview, Quezon
City.
3. That said loan, now overdue, is evidenced by a Contract of Loan
signed by the defendant, a copy of which is hereto attached as
annex A and made an integral part of this complaint.
4. That on or about January 07, 2015, the defendant obtained a loan
from the plaintiff in the sum of Seven Hundred Thousand
Pesos (Php.700, 000.00) with 10% interest payable on October 7,
2015.

5. That said loan is already due and demandable last October 07,
2015, the defendant did not pay the plaintiff.
6. That Plaintiff sent a Demand Letter to the Defendant directing him
to pay for the full amount of the loan plus 10% interest.
7. That defendant has not paid said loan nor any part thereof,
despite plaintiffs demand for payment on January 7, 2016.
PRAYER
WHEREFORE plaintiff respectfully prays for judgment in its
favor through a decision directing the defendant:
1. To pay the plaintiff the sum of Seven Hundred Thousand Pesos
(P700,00) with interest at 10% until the amount is paid.
2. Attorneys Fees at 10% of the principal amount
3. The cost of this suit.
4. Other just and equitable reliefs are likewise prayed for.
Quezon City, Philippines, 18 February, 2016.

ATTY. RIMAH MACABANGON

Counsel for
Plaintif
# 145 North Fairview, Quezon City,
Roll #: 12345
PTR No. 54321 01-0716 Quezon City
IBP No. 4321 0107-16

VERIFICATION AND CERTIFICATION

OF NON-FORUM SHOPPING
REPUBLIC OF THE PHILIPPINES)
CITY OF QUEZON CITY

S.S.

I, ABC, Filipino, of legal age and residing at No.17 Adrian Street,

North Fairview, Quezon City, after being sworn to in accordance with law,
depose and says that:
1. I am the Plaintiff in the above-entitled case.
2. That facts stated in the above complaint are true and correct to
the best of my knowledge and authentic records.
3. I have not commenced any action or filed any claim involving the
same issues in any court, tribunal or quasi-judicial agencies and,
to the best of my knowledge, no such other action or claim is
pending in them; and
4. If I should learn that the same or similar action or claim has been
filed or is pending after its filing, I shall report that fact within five
(5) days from notice to the court or where the complaint or
initiatory pleading has been filed.
February 18, 2016 at Quezon City.

ABC
Affiant

SUBSCRIBED AND SWORN to before me, this 18th day of

February, 2016, in the City of Quezon City by ABC with Identification Card No.
1234, issued on January 4, 2016 at Quezon City.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of ______.

NOTARY PUBLIC
Commission Serial No. ___
Until Dec. 31, 2017
Roll of Attorney: 12345
PTR No. 54321 01-

07-16 Quezon City

IBP No. 4321
01-07-16 Quezon City