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The Lawphil Project Arellano Law Fovndation

FORM 1-A-SCC
REPUBLIC OF THE PHILIPPINES
_______________________________
_______________________________
_______________________________

______________________________,
Plaintiff,
vs.

Civil Case No. ___________________


For: __________________________

______________________________,
Defendant
x------------------------------------------------x
STATEMENT OF CLAIM
Plaintiff respectfully alleges:
1. The personal circumstances of the parties are as follows:
NAME OF PLAINTIFF/S
_____________________________

SEX
AGE
______ ______

CIVIL STATUS
________________

INDIVIDUAL ___ CORPORATION ___ PARTNERSHIP ___ SOLE PROPRIETORSHIP ___


NAME OF REPRESENTATIVE: _________________________________________________
ADDRESS
______________________________________________________________

ZIP CODE
_________

NAME OF DEFENDANTS//S

SEX

AGE

CIVIL STATUS

_____________________________

_____

_____

________________

INDIVIDUAL ___ CORPORATION ___ PARTNERSHIP ___ SOLE PROPRIETORSHIP ___


NAME OF REPRESENTATIVE: _________________________________________________
ADDRESS
______________________________________________________________

ZIP CODE
_________

2. Plaintiff is suing defendant for:


CAUSE OF ACTION
Collection of Sum of Money
Damages
Civil aspect of Criminal Case
Enforcement of Barangay Agreement

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