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    Small Claims Form

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    anon_249983991
    This document is a statement of claim filed in a municipal trial court. It provides personal information about the plaintiff, Iloilo Finance Corporation, and three defendants - William Dungog, Georgie Floro, and Joseph Areño. The plaintiff claims the defendants owe ₱55,819 as of June 30, 2011 for a loan obtained by Dungog and Areño from Floro, who then assigned the credit to Iloilo Finance Corporation. The plaintiff asks the court to order payment of the money owed plus a 3% monthly penalty charge on unpaid amounts. Documents like a promissory note and deed of assignment are provided as proof of the debt.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Small Claims Form

    Uploaded by

    anon_249983991
    359 views10 pages
    This document is a statement of claim filed in a municipal trial court. It provides personal information about the plaintiff, Iloilo Finance Corporation, and three defendants - William Dungog, Georgie Floro, and Joseph Areño. The plaintiff claims the defendants owe ₱55,819 as of June 30, 2011 for a loan obtained by Dungog and Areño from Floro, who then assigned the credit to Iloilo Finance Corporation. The plaintiff asks the court to order payment of the money owed plus a 3% monthly penalty charge on unpaid amounts. Documents like a promissory note and deed of assignment are provided as proof of the debt.

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    This document is a statement of claim filed in a municipal trial court. It provides personal information about the plaintiff, Iloilo Finance Corporation, and three defendants - William Dungog, Georgie Floro, and Joseph Areño. The plaintiff claims the defendants owe ₱55,819 as of June 30, 2011 for a loan obtained by Dungog and Areño from Floro, who then assigned the credit to Iloilo Finance Corporation. The plaintiff asks the court to order payment of the money owed plus a 3% monthly penalty charge on unpaid amounts. Documents like a promissory note and deed of assignment are provided as proof of the debt.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    359 views10 pages

    Small Claims Form

    Uploaded by

    anon_249983991
    This document is a statement of claim filed in a municipal trial court. It provides personal information about the plaintiff, Iloilo Finance Corporation, and three defendants - William Dungog, Georgie Floro, and Joseph Areño. The plaintiff claims the defendants owe ₱55,819 as of June 30, 2011 for a loan obtained by Dungog and Areño from Floro, who then assigned the credit to Iloilo Finance Corporation. The plaintiff asks the court to order payment of the money owed plus a 3% monthly penalty charge on unpaid amounts. Documents like a promissory note and deed of assignment are provided as proof of the debt.

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    © All Rights Reserved
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    The document outlines a legal case filed by Iloilo Finance Corporation against William Dungog for collection of money owed. It provides details of the parties involved and the amount owed according to the plaintiff.

    The case is a collection case filed by Iloilo Finance Corporation against William Dungog to recover an amount of ₱55,819.00 plus interest that is owed.

    The plaintiff is Iloilo Finance Corporation, a corporation with its principal place of business in Iloilo City. The defendant is William Dungog, an individual residing in Oton, Iloilo. Details like their addresses and contact information are provided.

    FORM 1-SCC

    Page (pahina) 1
    REPUBLIC OF THE PHILIPPINES
    MUNICIPAL TRIAL COURT IN CITIES
    ILOILO CITY
    Iloilo Finance Corporation,
    Plaintiff,
    vs.

    Civil Case No. _______________


    For: Collection of Money

    William Dungog, Georgie C. Floro


    and Joseph C. Areo,
    Defendants.
    x - - - - - - - - - - - - - - - - - - - - - - - - - - - -x

    THIS FORM IS NOT FOR SALE


    AND MAY BE REPRODUCED
    (Ang FORM na ito ay LIBRE at maaaring kopyahin)
    STATEMENT OF CLAIM
    (HABLA NG PAGSINGIL)
    1. The personal circumstances of the parties are as follows:
    (Ang bawat panig ay ang mga sumusunod)
    ILOILO FINANCE CORPORATION
    NAME OF PLAINTIFF/S
    STATUS
    (Pangalan ng Naghahabla)
    (Katayuang Sibil)

    ________
    SEX

    _______
    AGE

    (Kasarian)

    ________
    CIVIL

    (Edad)

    (Put a check on any of the following)


    (Pumili sa mga sumusunod at lagyan ng tsek)

    []

    [/]

    INDIVIDUAL

    (Tao/Indibidwal)

    []

    CORPORATION

    PARTNERSHIP

    (Korporasyon)

    [ ]COOPERATIVE
    (Kooperatiba)

    (Bakasan)

    []

    SOLE PROPRIETORSHIP
    (Solong Pagmamay-ari)

    HOME ADDRESS: (City) __________________________


    Pahatirang Sulat sa Bahay) [Lungsod]
    Zip Code

    _________

    (Province, if applicable)______________________________

    ________

    Zip

    (Lalawigan, kung meron)


    Code
    Telephone No. _3375652, 3375360
    (Telepono Blg.)

    Cellphone No. _______________


    (Selpon Blg.)

    PLACE OF WORK : ILOILO FINANCE CORP., C. YOUNG BLDG. SOLIS ST.,


    ILOILO CITY
    (Lugar ng Pinagtatrabahuhan)
    FORM 1-SCC
    Page (pahina) 2
    NAME OF REPRESENTATIVE, if applicable ARLENE L. LOCSIN
    (Pangalan ng Kinatawan, kung meron)
    HOME ADDRESS:

    (City) c/o Iloilo Finance Corporation, C. Young Bldg.


    Solis St., Iloilo City
    5000 (Pahatirang Sulat sa Bahay) [Lungsod]
    Zip Code
    (Province, if applicable)______________________________
    ________
    (Lalawigan, kung meron)
    Zip Code
    Telephone No. 3375652, 3375360
    _______________
    (Telepono Blg.)
    WILLIAM DUNGOG
    NAME OF DEFENDANT/S
    STATUS
    (Pangalan ng Hinahabla)
    (Katayuang Sibil)

    [/]

    INDIVIDUAL
    (Tao/Indibidwal)
    (Bakasan)

    Cellphone No.
    (Selpon Blg.)

    _____
    SEX
    (Kasarian)

    []CORPORATION

    ______________
    AGE
    CIVIL
    (Edad)

    []PARTNERSHIP

    (Korporasyon)

    []COOPERATIVE
    (Kooperatiba)

    []

    SOLE PROPRIETORSHIP
    (Solong Pagmamay-ari)

    HOME ADDRESS:
    (City) _________________________________________
    ________
    (Pahatirang Sulat sa Bahay) [Lungsod]
    Code

    Zip

    5020

    (Province, if applicable)Florvel Homes, Buray, Oton, Iloilo


    Zip

    (Lalawigan, kung meron)


    Code

    Telephone No. ______________________Cellphone No. _______________


    (Telepono Blg.)
    (Selpon Blg.)
    PLACE OF WORK __________________________________________________________
    (Lugar ng Pinagtatrabahuhan)
    NAME OF REPRESENTATIVE, if applicable_________________________________
    (Pangalan ng Kinatawan, kung meron)
    HOME ADDRESS:
    (City) ________________________________________
    ________
    (Pahatirang Sulat sa Bahay) [Lungsod]
    Code
    (Province, if applicable)______________________________
    (Lalawigan, kung meron)

    Zip

    ________
    Zip

    Code

    Telephone No. ______________________Cellphone No. _______________


    (Telepono Blg.)
    (Selpon Blg.)
    PLACE OF WORK __________________________________________________________
    (Lugar ng Pinagtatrabahuhan)
    Telephone No. ______________________Cellphone No.
    _________________
    (Telepono Blg.)
    (Selpon Blg.)
    If more than one (1) defendant, list next defendant here:
    (Kung higit sa isa (1) ang Hinahabla, ilagay ang susunod na
    hinahabla
    rito:)
    FORM 1-SCC
    Page (pahina) 3
    GEORGIE C. FLORO
    NAME OF DEFENDANT/S
    CIVIL STATUS
    (Pangalan ng Hinahabla)
    (Katayuang Sibil)

    __M___

    [/]

    []CORPORATION

    INDIVIDUAL

    (Tao/Indibidwal)

    []

    ____
    SEX

    __________
    AGE

    (Kasarian) (Edad)

    PARTNERSHIP
    (Korporasyon)

    (Bakasan)

    []

    COOPERATIVE
    (Kooperatiba)

    []

    SOLE PROPRIETORSHIP
    (Solong Pagmamay-ari)

    HOME ADDRESS: (City)_________________________________


    (Pahatirang Sulat sa Bahay) [Lungsod]
    Code

    ________
    Zip

    (Province, if applicable) Florvel Homes, Buray, Oton


    5020
    Zip

    (Lalawigan, kung meron)


    Code
    Telephone No. ______________________Cellphone No. _______________
    (Telepono Blg.)
    (Selpon Blg.)

    PLACE OF WORK __________________________________________________________


    (Lugar ng Pinagtatrabahuhan)
    NAME OF REPRESENTATIVE, if
    applicable_____________________________________
    (Pangalan ng Kinatawan, kung meron)
    HOME ADDRESS:
    (City) ________________________________________
    ________
    (Pahatirang Sulat sa Bahay) [Lungsod]
    Code
    (Province, if applicable)______________________________
    (Lalawigan, kung meron)
    Code

    Zip

    ________
    Zip

    Telephone No. ______________________Cellphone No. _______________


    (Telepono Blg.)
    (Selpon Blg.)
    PLACE OF WORK __________________________________________________________
    (Lugar ng Pinagtatrabahuhan)
    Telephone No. ______________________Cellphone No. _______________
    (Telepono Blg.)
    (Selpon Blg.)

    JOSEPH C. AREO______
    ______________
    NAME OF DEFENDANT/S
    STATUS
    (Pangalan ng Hinahabla)
    (Katayuang Sibil)

    M__
    SEX

    ____
    AGE
    (Kasarian) (Edad)

    CIVIL

    [/]

    []CORPORATION

    INDIVIDUAL

    []

    PARTNERSHIP

    (Tao/Indibidwal)

    []

    COOPERATIVE
    (Kooperatiba)

    (Korporasyon)

    []

    (Bakasan)

    SOLE PROPRIETORSHIP
    (Solong Pagmamay-ari)

    HOME ADDRESS: (City) Magsaysay Village, Lapaz, Iloilo City


    (Pahatirang Sulat sa Bahay) [Lungsod]
    Code
    (Province, if applicable) _______________________

    5000
    Zip

    ________
    Zip

    (Lalawigan, kung meron)


    Code
    Telephone No. ______________________Cellphone No. _______________
    (Telepono Blg.)
    (Selpon Blg.)

    PLACE OF WORK __________________________________________________________


    (Lugar ng Pinagtatrabahuhan)
    NAME OF REPRESENTATIVE, if
    applicable_____________________________________
    (Pangalan ng Kinatawan, kung meron)
    HOME ADDRESS:
    (City) ________________________________________
    ________
    (Pahatirang Sulat sa Bahay) [Lungsod]
    Code
    (Province, if applicable)______________________________
    (Lalawigan, kung meron)
    Code

    Zip

    ________
    Zip

    Telephone No. ______________________Cellphone No. _______________


    (Telepono Blg.)
    (Selpon Blg.)
    PLACE OF WORK __________________________________________________________
    (Lugar ng Pinagtatrabahuhan)
    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.)
    FORM 1-SCC
    FOR OFFICIAL USE ONLY
    (Para sa Opisyal na gamit lamang)
    To be accomplished by the Branch Clerk of Court

    (Sasagutan ng Kawani ng Hukuman)

    Page (pahina) 4

    2. Plaintiff claims the


    defendants
    owes 55,819.00 as June 30,
    2011 .
    (Ang Hinahabla ay umutang
    sa
    Naghahabla ng halagang
    (55,819.00)
    (a) Why does the defendant
    owe
    plaintiff money?
    (Bakit ang Hinahabla ay
    nagkautang ng salapi sa
    Naghahabla?)
    Defendants Dungog and Areo
    obtained a loan from defendant
    Floro. Floro, holding himself
    solidarily liable, then assigned the
    credit to IFC. Thus, IFC is now the
    creditor and can collect the loan.
    (If you need more space, please use
    the back page). (Kung kailangan mo
    ng karagdagang patlang, maaaring
    gamitin ang likod ng pahinang ito.)

    1. Cause of action
    ____ Check
    __/_ Promissory Note
    ____ Contract
    ___ Oral
    __/__ Written
    _____ Barangay Agreement
    _____ Injuries :
    ___ Accidental ___
    Intentional
    ______ Damage to Property
    ______ Other (Please specify):
    _____________________________________)
    2. ____ Barangay conciliation required.
    If yes, _____ Certificate to File
    Action
    _____ Compromise
    Agreement
    attached.
    ___/___ Barangay conciliation not
    required.
    Please state the reason) IFC is
    a corporation.

    (b) When did this happen?


    (Kailan ito nangyari?)
    Date: October 2005
    (Petsa)
    If no specific date, give the time period:
    (Kung walang tiyak na petsa, ibigay ang tantiyang panahon)
    Date started:______________
    (Petsa nagsimula)
    Through: ______________

    (Hanggang)
    (c) How did you compute the money owed to you? (Do not include
    court
    costs or fees)
    A penalty charge of 3% per month is imposed compounded every time
    defendants failed to pay the monthly instalment. Payments made by
    defendants are applied first on the penalty charge and if fully settled the
    excess if any is applied to principal.
    (Paano mo kinuwenta ang salaping inutang sa iyo?) [Hindi
    kasama
    ang bayad sa pagpapatala sa hukuman.]
    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
    (Oo)

    [] No
    (Hindi

    FORM 1-SCC
    Page (pahina) 5

    If no, explain: ________________________________________________


    (Kung hindi, ipaliwanag)
    (b) How did you ask the defendant?
    (Paano mo siningil ang Hinahabla?)

    []

    In person
    (Sa kanya mismo)

    [/]

    In writing
    _______________
    (Sa sulat)

    [/]By phone
    (Sa telepono)

    []Others (please specify)


    (Iba pa) [pakisulat kung paano]

    (c) When did you do this? March 2011


    (Kailan mo ginawa ito?)
    4. What is your proof that defendant owes you money? promissory note,
    deed of assignment, chattel mortgage, ledger.
    (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

    (Oo)

    (Hindi)

    6. Was this claim referred to the barangay?


    (Dumaan ba sa barangay ang paniningil na ito?)

    []

    []No

    Yes

    Covered
    (Oo)

    No

    [/]

    Not

    (Hindi)

    (Hindi sakop)
    State reason:
    (Isulat ang dahilan)
    IFC is a juridical
    entity
    If yes, do you have a Certificate to File Action or a Compromise
    Agreement executed before the barangay? N/A
    (Kung oo, meron ka bang Patunay sa Pagsampa ng Kaso o Kasunduan
    na
    isinagawa sa barangay?)
    6-A. In this court station, how many small claims cases have
    you filed within this calendar year prior to this present case?
    This is the first
    (Sa court station na ito, pang ilang kaso na itong isinampa mo
    sa loob ng kasalukuyang taon? ______)
    FORM 1-SCC
    Page (pahina) 6

    7. By the filing of this action, plaintiff hereby waives any amount in


    excess of P100,000.00, excluding interest and costs.
    (Sa pagsampa ng kasong ito, ang Naghahabla ay isinusuko ang
    anumang halaga na higit sa P100,000.00, hindi kasama ang tubo
    at

    gastos sa pagsampa ng kasong ito.)

    PRAYER
    (PAGSAMO)

    WHEREFORE, plaintiff respectfully prays for judgment ordering


    defendant to pay the amount of 55,819.00, with 3% penalty charge and
    legal interest per annum/per month from filing of this case until fully
    paid.
    (DAHIL DITO, ang Naghahabla ay magalang na sumasamo na
    igawad ang kapasiyahang utusan ang Hinahabla na magbayad sa
    Naghahabla ng halagang 55,819.00 pati ang 3% penalty charge at
    tubo na bawat taon/buwan simula sa paghabla hanggang ganap o
    lubos na mabayaran ito.)
    Iloilo City, Philippines, _______________, 20___.
    PLACE WHERE FILED
    (Lugar kung saan inihain)
    Iloilo Finance Corporation
    PLAINTIFF
    (Naghahabla)
    .
    by:
    Arlene L. Locsin
    CTC No. ___________
    Issued at Iloilo City
    Issued on __________

    VERIFICATION
    and
    CERTIFICATION OF NON-FORUM SHOPPING
    I, ARLENE L. LOCSIN, under oath depose and say:
    That I am the authorized representative of Iloilo Finance Corporation.
    That I have caused the preparation of the foregoing complaint, have read and
    understood the contents thereof and all the allegations contained therein are true and
    correct of my own personal knowledge and based on authentic record.

    That Iloilo Finance Corporation has not commenced any other action or
    proceedings involving the same or similar issues in the Supreme Court, the Court of
    Appeals, or different divisions thereof, or in any other tribunal and agency; and that no
    such action or proceeding is pending in the Supreme Court, Court of Appeals, or any
    divisions thereof or any other tribunal and agency; and
    That if I should thereafter learn that a similar action or proceeding has been filed
    or is pending before the Supreme Court, the Court of Appeals or any other tribunal or
    agency, I undertake to report such fact within five (5) days therefrom to the Court or
    agency wherein the original complaint has been filed.
    IN WITNESS WHEREOF, I hereunto
    _____________________ at Iloilo City, Philippines.

    affixed

    my

    signature

    this

    ARLENE L. LOCSIN
    Affiant
    C.T.C. No. 09790401
    Issued at Iloilo City
    Issued on February 3, 2011
    REPUBLIC OF THE PHILIPPINES )
    CITY OF ILOILO
    )S.S.

    JURAT/NOTARIAL CERTIFICATE
    The principal, whose name and personal circumstances are stated above, appeared in
    person before me this _______________________ in the City of Iloilo, presented the foregoing
    instrument, signed the same in my presence, and affirmed or swore under oath to the truth and
    correctness of the contents and allegations of the same.
    IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notarial seal on
    the date and place above-written.
    Doc. No. _______
    Page No. _______
    Book No. _______
    Series of 2011.

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