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Page 1 of 5, COMPLAINT, David vs.

Melendres

Republic of the Philippines


REGIONAL TRIAL COURT
5th Judicial Region
Branch 64
Labo, Camarines Norte
Gloren Jean David,
Plaintiff,
Civil Case No. _____________
- versus For: QUASI-DELICT
Noel Melendres,
Defendant,
x-----------------x
COMPLAINT
COMES NOW Plaintiff, by counsel and to this Honorable Court,
respectfully states that:
1. Plaintiff Gloren Jean David is of legal age, Filipino, widow, and a resident
of Anahaw, Labo, Camarines Norte, Philippines. For purposes of this
action, plaintiff may be served with all orders, notices, and other processes
of this Honorable Court through the office address of the undersigned
counsel indicated below;
2. Defendant Noel Melendres , of legal age, Filipino, married, and may be
served with summons and other processes of this Honorable Court at his last
known address at Bautista, Labo, Camarines Norte, Philippines;
3.

On or about 10:00 oclock in the morning on July 16, 2012 under fair
weather condition, along the Maharlika Highway at the portion of Iberica
Labo, Camarines Norte, the above-named defendant, being then the driver
of SUZUKI Pick-up colored white bearing Plate No. EVG 231 registered in

Page 2 of 5, COMPLAINT, David vs. Melendres

his name, drive and operate said vehicle in a negligent, reckless and careless
manner and without due regard to traffic laws and regulations to prevent
accident to persons and property, and as a result of such negligence, reckless
and carelessness said Suzuki pick-up rammed into the house and tailoring
shop of the plaintiff Gloren Jean David and her husband, instantly killing
Danilo David, her husband who was standing at the doorway of the house at
the time the collision occurred.

5. As a result of the untimely death of the plaintiffs husband who was the sole
breadwinner, the latters heirs will be deprived of the support equivalent to
the future income of the victim.

6. By the same negligent act of the defendant, plaintiff Gloren Jean David has
suffered serious physical injury and has incurred hospital and medical
expenses in the amount of no less than P100,000.00 and rendered their
sewing machine a total wrecked and no longer serviceable, and cost of repair
of the shop which amount may be fixed at P 120,000.00.

7. That the plaintiff demanded from the defendants of just and equitable and
reasonable death compensation and reimbursement of actual and hospital
expenses by reason of the mishap but defendant refused and continue to
refuse to heed plaintiffs demand.

Page 3 of 5, COMPLAINT, David vs. Melendres

PRAYER
WHEREFORE, after due notice and hearing, Plaintiff respectfully prays
that judgment be rendered against the Defendant as follows:
1. Ordering the Defendant to:
a. Indemnify the heirs of the deceased, Danilo David due to the
latters death in the amount of P50,000 as death compensation,
further sum of P 40,000 as burial and incidental expenses and the
amount of P500,000 as loss of earning capacity
b. Indemnify the plaintiff Gloren Jean David in the amount of P
100,000 as reimbursement for hospital and medical expenses;
c. Pay the plaintiff in the amount of P120,000 for the replacement of
sewing machine and repair of the shop.
d. Pay the amount of P15,000 as attorneys fee, P 1,000 as appearance
fee per hearing and reimbursement of the docket fee.
e. To pay the plaintiff moral and exemplary damages in such amount
as the Honorable court may equitably fix and such other reliefs
just and reasonable under the circumstances.
2. Plaintiff respectfully prays for such other reliefs as may be just and
equitable in the premises.
Labo, Camarines Norte, Philippines, July 19, 2012.
NIO B. RARO
Counsel for the Plaintiff
Labo, Camarines Norte
IBP ROLL No. 12345
PTR No. 54321

Page 4 of 5, COMPLAINT, David vs. Melendres

VERIFICATION
REPUBLIC OF THE PHILIPPINES)
Province of Camarines Norte
) S.S.
Municipality of Labo
)
x-----------------------x
I, Gloren Jean David, of legal age, Filipino, widow, and a resident of
Calasgasan, Daet, Camarines Norte Philippines, after being sworn in accordance
with law, hereby depose and say:
That I am the Plaintiff in the above-entitled case; That I have caused the
preparation of the above Complaint and I have read the same and knows the
contents thereof; That the allegations contained therein are true and correct of my
own personal knowledge.
IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of
JULY 2012 at Labo, Camarines Norte, Philippines.
GLOREN JEAN DAVID
AFFIANT
SUBSCRIBED AND SWORN to before me, this 19th day of July, 2012 by
Gloren Jean David who exhibited to me her Community Tax Certificate No.
123456789 issued at Daet, Camarines Norte, Philippines on January 3, 2012.
NIO B. RARO
NOTARY PUBLIC
Doc. No. __1____;
Page No. __1____;
Book No. __1____;
Series of 2012;

CERTIFICATION OF NON-FORUM SHOPPING


REPUBLIC OF THE PHILIPPINES)
Province of Camarines Norte
) S.S.
Municipality of Labo
)
x-----------------------x
I, Gloren Jean David, of legal age, Filipino, widow, and a resident of
Calasgasan, Daet, Camarines Norte Philippines, after being sworn in accordance
with law, hereby depose and certify that:

Page 5 of 5, COMPLAINT, David vs. Melendres

(a) I have not theretofore commenced any other action or proceeding or filed
any claim involving the same issues or matter in any court, tribunal, or quasi-judicial
agency and, to the best of my knowledge, no such action or proceeding is pending
therein; (c) if I should thereafter learn that the same or similar action or proceeding
has been filed or is pending before the Supreme Court, the Court of Appeals, or any
other tribunal or quasi-judicial agency, I undertake to report such fact within five (5)
days therefrom to the court or agency wherein the original pleading and sworn
certification contemplated herein have been filed.
IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of
July 2012, at Labo, Camarines Norte, Philippines.
GLOREN JEAN DAVID
AFFIANT

SUBSCRIBED AND SWORN to before me, this 19th of July 2012, by


Gloren Jean David who exhibited to me her Community Tax Certificate
No.123456789 issued at Labo, Camarines Norte, Philippines on January 3, 2012.
NIO B. RARO
NOTARY PUBLIC
Doc. No. ___2___;
Page No. ___2___;
Book No. ___2___;
Series of 2012
;