MCF No.

21
Request for Subpoena

Original Court, 1st Copy Plaintiff, 2nd Copy Defendant, Other copies as needed
Enter information in block letters in all parts of the Form except when reserved for Court
use, which shall be completed by the Clerk.
For Court Use Only
(Judicial Region)

(Municipality/City/Province)

METC/MTCC/MTC/MCTC
RTC

BRANCH
Case No.
Plaintiff/
Petitioner , v.
Defendant/
Respondent

COUNSEL OR PARTY WITHOUT COUNSEL

Nam
e
Firm Name
Address
Email Address
Tel./Cel./Fax Nos.
PTR No. Date/
Roll No. Place of Issue
Lifetime
IBP No. Date/Chapter
Compliance
MCL Exemption No
E .
Other Compliances
Counsel for
Plaintiff/
Petitioner
Defendant/
Respondent
Other

REQUEST FOR SUBPOENA

UNDER RULE 21.1 AND SECTION 5 OF THE JUDICIAL
AFFIDAVIT RULE

(name)
requests the Branch Clerk of Court to issue a Subpoena Ad
Testificandum Duces Tecum for each of the following witnesses:
For Court Use Only
Date Served
1. Name
Address
Remarks:
Telephone No.
Other Address

to attend and testify at the hearing on

(date/time)

page 1 of 3
 for the taking of his/her deposition on at
(date/time) (place)
for the taking of his/her judicial affidavit at
(date/time) (place)

Method of Service Requested as agreed upon by parties:

Personal Service
Registered Mail

Licensed Courier (as agreed upon by the parties)

Facsimile or other Electronic Means (as agreed upon by the

parties)
For Court Use Only
Date Served
2. Name
Address
Remarks:
Telephone No.
Other Address

to attend and testify at the hearing on

(date/time)
for the taking of his/her deposition on at
(date/time) (place)
for the taking of his/her judicial affidavit at
(date/time) (place)

Method of Service Requested:

Personal Service
Registered Mail
Licensed Courier (as agreed upon by the parties)
Facsimile or other Electronic Means (as agreed upon by the parties)

For Court Use Only

Date Served
3. Name
Address
Remarks:
Telephone No.
Other Address

to attend and testify at the hearing on

(date/time)
for the taking of his/her deposition on at
(date/time) (place)
for the taking of his/her judicial affidavit at
(date/time) (place)

Method of Service Requested:

Personal Service Registered Mail

REQUEST FOR SUBPOENA AD TESTIFICANDUM page 2 of 3

 Licensed Courier Facsimile or other Electronic
Means

____________________ ____________________________________
Date Party/Partys Counsel Name and Signature

ORDER
The Request is

granted. The Branch Clerk of Court is directed to issue the Subpoena

as requested above.

as requested above, subject to ______________________________

(state condition)

to the following individuals __________________________

only:

Failure without adequate cause is to obey a subpoena serve upon him shall be deemed a
contempt of the court.
denied, the request is not made for a valid purpose.
set for hearing on _______________________________

_______________________ _____________
Judge Date

SPECIAL INSTRUCTIONS

REQUESTERS RESPONSIBILITIES
The requester shall bear the cost of the Subpoenas service upon the witness and the
responsibility for ensuring that such service is made. The requester must also advance to
the witness the actual costs of attending the hearing.

REQUEST FOR SUBPOENA AD TESTIFICANDUM page 3 of 3