Comp. Form
Comp. Form
2008
COMPLAINANT/s: Name, Sex, Age & Address RESPONDENT/s: Name, Sex, Age & Address
___________________________________
___________________________________________
_____________________________________
___________________________________________
1. Has a similar complaint been filed before any other office?* YES ___ NO _X_
2. Is this complaint in the nature of a counter-charge?* YES ___ NO _X_ If yes, indicate details below:
3. Is this complaint related to another case before this office?* YES ___ NO _X_ If yes, indicate details below:
C E R T I F I C A T I O N*
I CERTIFY, under oath, that all the information on this sheet are true and correct to the best of my
knowledge and belief, that I have not commenced any action or filed any claim involving the same issues in any
court, tribunal, or quasi-judicial agency, and that if I should thereafter learn that a similar action has been filed
and/or is pending, I shall report that fact to this Honorable Office within five (5) days from knowledge thereof.
SUBSCRIBED AND SWORN TO before me this __ day of _________ 2017 in Calamba City.
*1, 2, 3 and CERTIFICATION need not be accomplished for inquest cases.