2016 REVISED RULES OF PROCEDURE ON SMALL CLAIMS CASES

FORM 1-SCC

REPUBLIC OF THE PHILIPPINES

MUNICIPAL TRIAL COURT IN CITIES
JUDICIAL REGION 7
CITY OF LAPU-LAPU

NAME,
Plaintiff,

-vs- For: SUMS OF MONEY AND

DAMAGES

NAME,
Defendant(s).
x---------------------------------------x

STATEMENT OF CLAIM
(HABLA NG PAGSINGIL)

1. The personal circumstances of the parties are as follows:

(Ang bawat panig ay ang mga sumusunod)

NAME OF PLAINTIFF/S SEX AGE CIVIL STATUS

(Pangalan ng Naghahabla) (Kasarian) (Edad) (Katayuang Sibil)

(Put a check on any of the following)

(Pumili sa mga sumusunod at lagyan ng tsek)

✔ INDIVIDUAL CORPORATION PARTNERSHIP

(Tao/Indibidual) (Korporasyon) (Bakasan)

COOPERATIVE SOLE PROPRIETORSHIP

(Kooperatiba) (Solong Pagmamay-ari)

NATURE OF BUSINESS:
(Uri ng Negosyo)

BANKING LENDING
(Bangko) (Pagpapautang)

✔ OTHERS/PLEASE INDICATE: PERSONAL

(Iba pang uri ng negosyo)

PLAINTIFF’S HOME ADDRESS:

(Pahatirang Sulat sa Bahay ng Naghahabla)

City
(Lungsod) Zip Code

Province, if applicable
(Lalawigan, kung meron) Zip Code

Telephone No. Cellphone No.

(Telepono Blg.) (Selpon Blg.)

PLACE OF WORK:
(Lugar ng Pinagtrabahuan)

Telephone No. Cellphone No.

(Telepono Blg.) (Selpon Blg.)

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 2016 REVISED RULES OF PROCEDURE ON SMALL CLAIMS CASES

NAME OF PLAINTIFF’S REPRESENTATIVE:

if applicable (must be a non-lawyer)

(Pangalan ng Kinatawan:)
(kung meron) [dapat hindi abogado]

HOME ADDRESS:
City
(Lungsod) Zip Code

Province, if applicable
(Lalawigan, kung meron) Zip Code

Telephone No. Cellphone No.

(Telepono Blg.) (Selpon Blg.)

PLACE OF WORK:
(Lugar ng Pinagtrabahuan)

Telephone No. Cellphone No.

(Telepono Blg.) (Selpon Blg.)

NAME OF DEFENDANT/S SEX AGE CIVIL STATUS

(Pangalan ng Naghahabla) (Kasarian) (Edad) (Katayuang Sibil)

✔ INDIVIDUAL CORPORATION PARTNERSHIP

(Tao/Indibidual) (Korporasyon) (Bakasan)

COOPERATIVE SOLE PROPRIETORSHIP

(Kooperatiba) (Solong Pagmamay-ari)

DEFENDANT’S HOME ADDRESS:

(Pahatirang Sulat sa Bahay ng Hinahabla)

City
(Lungsod) Zip Code

Province, if applicable
(Lalawigan, kung meron) Zip Code

Telephone No. Cellphone No.

(Telepono Blg.) (Selpon Blg.)

PLACE OF WORK:
(Lugar ng Pinagtrabahuan)

Telephone No. Cellphone No.

(Telepono Blg.) (Selpon Blg.)

NAME OF DEFENDANT’S REPRESENTATIVE:

if applicable (must be a non-lawyer)

(Pangalan ng Kinatawan:)
(kung meron) [dapat hindi abogado]

HOME ADDRESS:
City
(Lungsod) Zip Code

Province, if applicable
(Lalawigan, kung meron) Zip Code

Telephone No. Cellphone No.

(Telepono Blg.) (Selpon Blg.)

PLACE OF WORK:

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 2016 REVISED RULES OF PROCEDURE ON SMALL CLAIMS CASES

(Lugar ng Pinagtrabahuan)

Telephone No. Cellphone No.

(Telepono Blg.) (Selpon Blg.)

*Note: If you need more space, you can write at the back of this Form.
(*Tala: Kung kailangan mo ng karagdagang patlang, maaari mong isulat sa likod ng Form na ito.)

2. Plaintiff claims the defendant owes it

FOR OFFICIAL USE ONLY (Para sa Opisyal
na gamit lamang)
(Ang Hinahabla ay umutang ng Naghahabla ng halagang) - To be accomplished by the Branch Clerk of Court-

(a) Why does the defendant owe plaintiff money? (Sasagutan ng Kawani ng Hukuman)
(Bakit ang Hinahabla ay nagkautang ng salapi sa
Naghahabla?) 1. Cause of action Check
Promissory Note
Contract
(b) When did this happen?
Oral Written
Barangay Agreement

Date: Others (Please specify):

_________________________________.
(Petsa)

(c) How did you compute the money owed to you? (Do not 2. _____ Barangay conciliation required. If yes, _____
include court costs or fees) Certificate to File Action
_____ Compromise Agreement attached.
_____ Barangay conciliation not required.

Please state the reason):

________________________________________.
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)

(b) How did you ask the defendant?

(Panno mo siningil ang Hinahabla?)

In person ✔ By phone
(Sa kanya mismo) (Sa telepono)

✔ In writing ✔ Others (please speficy)

(Sa sulat) (Iba pa) [pakisulat kung paano]

(c) When did you do this?

(Kialan mo ginawa ito?)

Several occasions, starting March 7, 2018.

4. What is your proof that defendant owes you money?

(Ano ang iyong katibayan o pruweba na ang Hinahabla ay may utang na salapi sa iyo?)

5. Did you attach your proof to this form?

(Iyo bang inilakip ang katibayan o pruweba sa Form na ito?)

✔ Yes No
(Oo) (Hindi)

6. Was this claim referred to the barangay?

(Dumaan ba sa barangay and paniningil na ito?

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 2016 REVISED RULES OF PROCEDURE ON SMALL CLAIMS CASES

✔ Yes No Not Covered

(Oo) (Hindi) (Hindi sakop)

State reason:
(Isulat ang dahilan)

If yes, do you have a Certificate to File Action or a Compromise Agreement executed before the barangay?
(Kung oo, meron ka bang Patunay sa Pagsampa ng Kaso o Kasunduan na isinagawa sa barangay?)

6-A. How many small claims cases have you filed within this calendar year prior to this present case, in this
court station and the entire country?
(Pang ilang kaso na itong sinampa mo sa loob ng kasalukuyang taon sa korte na ito at sa buong bansa?)

7. By the filing of this action, plaintiff hereby waives any amount in excess of P200,000.00, excluding interest and
costs.
(Sa pagsampa ng kasong ito, ang Naghahabla ay isinusuko ang anumang halaga na higit sa P200,000.00, hindi
kasama ang tubo at gastos sa pagsampa ng kasong ito.

PRAYER
(PAGSAMO)

WHEREFORE, Plaintiff respectfully prays for judgment ordering defendant(s) to pay the amount of P
_________damages, costs of suit, interest rate of 12 % per annum from ________ until fully paid, and all other remedies
the court may deem just and proper, such as the cancellation of the amount of ________ that was waived by the Plaintiff
in entering into the Compromise Agreement.

(DAHIL DITO, ang Naghahabla ay magalang na sumasamo na igawad ang kapasiyahang utusan ang Hinahabla
na magbayad sa Naghahabla ng halagang P_____________, pati ang tubo na ______% bawat taon/ buwan simula
_______________ hanggang ganap o lubos na mabayaran ito.)

CITY OF CEBU, ____________, 2017.

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 2016 REVISED RULES OF PROCEDURE ON SMALL CLAIMS CASES

FORM 1-A-SCC

VERIFICATION AND CERTIFICATION AGAINST

NON-FORUM SHOPPING, SPLITTING A SINGLE
CAUSE OF ACTION AND MULTIPLICITY OF SUITS

I,_________________________ of legal age, _________________, (name) (citizenship)

__________________, and a resident of _________________________, (civil status) (residence)

on oath, state:

1. That I am the authorized representative in the above-entitled case have caused this small claims form
to be prepared; that I read and understood its contents which are true and correct of my own personal
knowledge and/or based on true records;

2. That I have not commenced any action or proceeding involving the same issue or subject matter, and
specifically the same check/s in the Supreme Court, the Court of Appeals or any other tribunal or agency,
particularly before the Office of the City Prosecutor of Lapu-Lapu.
; that to the best of my knowledge, no such action or proceeding is pending in the Supreme Court, the Court
of Appeals or any other tribunal or agency, and that, if I should learn thereafter that a similar action or
proceeding has been filed or is pending before these courts or tribunal or agency, I undertake to report that
fact to the Court within five (5) days therefrom.

3. That the filing of this case is not in violation of the rule against splitting a single cause of action or
multiplicity of suits.

4. That I knowingly and voluntarily waive and forego the institution of any criminal complaint for
Violation of Batas Pambansa Blg. 22 against the defendant herein based on the same check/s subject matter
of this Small Claims Complaint.

IN WITNESS WHEREOF, I have hereunto set my hand this day of

______________, 20_____.

______________________
Affiant

SUBSCRIBED AND SWORN to before me this ____________ day of

______________, 20_____.

______________________
NOTARY PUBLIC