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CBF 12 Motion For Issuance of TPO
CBF 12 Motion For Issuance of TPO
Original Court, 1st Copy Prosecutor, 2nd Copy Accused, 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.
BRANCH
Other Compliances
Attorney for
Prosecution: Public Prosecutor Private Prosecutor
Defense: Public Attorney Private Counsel
Other
Movant, , states:
1. Movant is
the offended party.
the parent or guardian of the offended party
ascendant, descendant or collateral relative within the fourth civil
degree of consanguinity or affinity
an officer or social worker of the DSWD or social workers of local
government units (LGUs);
a police officer, preferably in charge of women and children's desks;
Punong Barangay or Barangay Kagawad;
the lawyer, counselor, therapist or healthcare provider of the
petitioner;
a concerned responsible citizens of the city or municipality where the
violence against women and their children occurred and who has
personal knowledge of the offense committed.
5. The aforesaid acts of violence have caused the movant great physical and
mental pain, suffering and anguish and have seriously impaired her physical and
mental health and development.
7. There is also reasonable ground to believe that the accused will inflict
violence against the family or household members of the movant, and for their
protection, they consent to a temporary protection order that the Honorable Court
may issue to prevent the occurrence or recurrence of such violence.
10. the applicant is not the offended party. Hence, the affidavit required
under Section 10 A.M. No. 4-10-11-SC is attached.
11. Movant prays for the issuance ex-parte of a Temporary Protection Order
enjoining the accused from threatening to commit or committing further acts of
violence against the offended party and the following family and household
member(s):
The applicant
Designated family and household members
The residence of the applicant
The school of the applicant
The place of employment of the applicant
The (specify) frequented by the applicant
The (specify) frequented by designated family and
household members
Ordering the accused from further communicating in any form with the
movant and/or her minor child/ren in the residence, in the school where the
movants minor child/ren are studying, in the place of employment of the
movant, and in the (specify) frequented by the movant.
Movant further prays that, after hearing, the Temporary Protection Order be
made permanent.
VERIFICATION
Name Date
Notary Public
Doc No. ;
Page No. ;
Book No. ;
Series of 20
PROOF OF SERVICE
A copy of this Motion was served upon parties and/or their counsel(s) on via
Personal Service
Facsimile or other Electronic Means
ORDER
Ordering the accused from further communicating in any form with the
movant and/or her minor child/ren in the residence, in the school where the
movants minor child/ren are studying, in the place of employment of the
movant, and in (specify place) frequented by the movant.
This temporary protection order is effective only for thirty (30) days
from service on the accused.
Judge Date
COPY FURNISHED
SPECIAL INSTRUCTIONS
Form of petition
A petition for protection order shall be in writing, signed and verified by the petitioner. It shall
be accompanied by a certificate of non-forum shopping which the petitioner must sign
personally. (Section 7, A.M. No. 4-10-11-SC)
The filing of a petition for protection order by the offended party suspends the right of all other
authorized parties to file similar petitions. A petition filed by the offended party after the filing of
a similar petition by an authorized party shall not be dismissed but shall be consolidated with the
petition filed earlier. (Section 8, A.M. No. 4-10-11-SC)
The verified petition for protection order may be filed with the Family Court of the place where
the offended party resides. If there is no existing Family Court, it may be filed with the regional
trial court, metropolitan trial court, municipal trial court in cities, municipal trial court or
municipal circuit trial court with territorial jurisdiction over the place of residence of the
offended party. (Section 9, A.M. No. 4-10-11-SC)
If the petitioner is not the offended party, the petition shall be accompanied by an affidavit of the
petitioner attesting to the following:
(a) facts showing the authority of the petitioner to file the petition;
(b) circumstances of the abuse suffered by the offended party; and
(c) circumstances of consent given by or refusal to consent of the offended party to file the
petition.
When disclosure of the address will pose danger to the life of the offended party, it shall be so
stated in the petition. In such a case, the petitioner shall attest that the offended party is; residing
in the municipality or city over which the court has territorial jurisdiction, and shall provide a
mailing address for purposes of service processing. (Section 10, A.M. No. 4-10-11-SC)
withhold, remit or any delay in the remittance of support to the offended party without
justifiable cause shall render the respondent or his employer liable for indirect contempt
of court;
(i) Prohibiting the respondent from carrying or possessing any firearm or deadly weapon and
ordering him to surrender the same to the court for appropriate disposition, including
revocation of license and disqualification to apply for any license to carry or possess a
firearm. If the respondent is .a law enforcement agent, the court shall order him to
surrender his firearm and shall direct the appropriate authority to investigate him and take
appropriate action thereon;
(j) Directing the DSWD or any appropriate agency to prepare a program of intervention for
the offended party that provides advocacy, temporary shelter, crisis intervention,
treatment, therapy, counseling, education, training and other social services that the
offended party may need;
(k) Requiring the respondent to receive professional counseling from agencies or persons
who have demonstrated expertise and experience in anger control, management of
alcohol, substance abuse and other forms of intervention to stop violence. The program of
intervention for offenders must be approved by the court. The agency or person is
required to provide the court with regular reports of the progress and result of
professional counseling, for which the respondent may be ordered to pay; and
(I) Awarding the offended party actual damages caused by the violence inflicted,
including, but not limited to, property damage, medical expanses, childcare
expenses and loss of income; and compensatory, moral, and exemplary
damages, subject to Sections 26a and 35 of this Rule.
The court may grant such other forms of relief to protect the offended party and any designated
family or household member who consents to such relief. (Section 11, A.M. No. 4-10-11-SC)