Republic of the Philippines

REGIONAL TRIAL COURT OF NEGROS ORIENTAL

Branch No.___
7th Judicial Region
Dumaguete City

___________, CIVIL CASE:__________

Petitioner,
FOR: PETITION FOR EX-PARTE
TEMPORARY PROTECTION
-versus- ORDER AND PERMANENT
PROTECTION ORDER WITH
PRAYER FOR CHILD SUPPORT
____________, PURSUANT TO R.A. 9262
Respondent.
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PETITION FOR EX-PARTE TEMPORARY

PROTECTION ORDER AND PERMANENT
PROTECTION ORDER WITH PRAYER FOR CHILD
SUPPORT
PURSUANT TO R.A. 9262

THE UNDERSIGNED LAW OFFICE, unto this most Honorable Court,

most respectfully enters its appearance as counsel for petitioner, __________. It is
humbly requested that the law office be furnished all the processes of this
Honorable Court in relation to the above-entitled case to its address:

PETITIONER, by undersigned counsels, most respectfully states THAT:

 PERSONAL CIRCUMSTANCES

1. Petitioner _________

2. Respondent _________

3. Petitioner with ________

4. Petitioner and Respondent _________

Machine copies ________

MATERIAL FACTS OF THE CASE

5. In the evening of __________;

6. The Respondent also threatened to burn their house causing __________

Machine copy of the _______

7. Petitioner herein immediately filed an application for barangay protection

order _________

Machine copy of the Application ________

8. The incident on 2020_______;

Machine copy of the Police _________

9. Petitioner, in many occasions, caught herein Respondent possessing a small

sachet of white-crystalline substance, _____________

CLAIM FOR FINANCIAL SUPPORT

10.Sometime in ___________;

11.Petitioner felt she is a stranger to her husband, ______________

 Machine copy of the __________

12. Respondent refused and still refused to give financial support ___________;

13.That by reason of respondent’s act, he has violated the highlighted

provisions under Section 5 of R.A. 9262 otherwise known as Anti-Violence
Against Women and their Children Act of 2004, to wit:

SECTION 5. Acts of Violence Against Women and Their

Children.- The crime of violence against women and their
children is committed through any of the following acts:

a. Causing physical harm to the woman or her child;

b. Threatening to cause the woman or her child physical

harm;

c. Attempting to cause the woman or her child physical

harm;

d. Placing the woman or her child in fear of imminent

physical harm;

e. Attempting to compel or compelling the woman or her

child to engage in conduct which the woman or her
child has the right to desist from or desist from conduct
which the woman or her child has the right to engage
in, or attempting to restrict or restricting the woman’s
or her child’s freedom of movement or conduct by
force or threat of force, physical or other harm or threat
of physical or other harm, or intimidation directed
against the woman or child. This shall include, but not
limited to, the following acts committed with the
purpose or effect of controlling or restricting the
woman’s or her child’s movement or conduct:

1. Threatening to deprive or actually depriving the

woman or her child of custody to her/his family;
 2. Depriving or threatening to deprive the woman
or her children of financial support legally due
her or her family, or deliberately providing the
woman’s children insufficient financial support;

3. Depriving or threatening to deprive the woman or

her child of a legal right;

4. Preventing the woman in engaging in any legitimate

profession, occupation, business or activity or
controlling the victim’s own money or properties, or
solely controlling the conjugal or common money,
or properties;

f. Inflicting or threatening to inflict physical harm on

oneself for the purpose of controlling her actions or
decisions;

g. Causing or attempting to cause the woman or her child

to engage in any sexual activity which does not
constitute rape, by force or threat of force, physical
harm, or through intimidation directed against the
woman or her child or her/his immediate family;

h. Engaging in purposeful, knowing, or reckless conduct,

personally or through another, that alarms or causes
substantial emotional or psychological distress to the
woman or her child. This shall include, but not be
limited to, the following acts:

1. Stalking or following the woman or her child in

public or private places;

2. Peering in the window or lingering outside the

residence of the woman or her child;

3. Entering or remaining in the dwelling or on the

property of the woman or her child against her/his
will;
 4. Destroying the property and personal belongings or
inflicting harm to animals or pets of the woman or
her child; and

5. Engaging in any form of harassment or violence;

i. Causing mental or emotional anguish, public

ridicule or humiliation to the woman or her child,
including, but not limited to, repeated verbal and
emotional abuse, and denial of financial support or
custody of minor children of access to the woman’s
child/children. (Bold supplied)

14. Petitioner is presently living with their children _________

15. Hence, Petitioner in order as security measures over her and her children, is
constrained to file this petition for the issuance of a Temporary Protection
Order and upon expiration thereof, a Permanent Protection Order in
accordance with Section 8 of R.A. 9262, which provides:

SECTION 8. Protection Orders.- A protection order is an

order issued under this act for the purpose of preventing further
acts of violence against a woman or her child specified in
Section 5 of this Act and granting other necessary relief. The
relief granted under a protection order serve the purpose of
safeguarding the victim from further harm, minimizing any
disruption in the victim’s daily life, and facilitating the
opportunity and ability of the victim to independently regain
control over her life. The provisions of the protection order
shall be enforced by law enforcement agencies. The protection
orders that may be issued under this Act are the barangay
protection order (BPO), temporary protection order (TPO) and
permanent protection order (PPO). The protection orders that
may be issued under this Act shall include any, some or all of
the following reliefs:

(a) Prohibition of the respondent from threatening to commit or

committing, personally or through another, any of the acts
mentioned in Section 5 of this Act;
(b) Prohibition of the respondent from harassing, annoying,
telephoning, contacting or otherwise communicating with the
petitioner, directly or indirectly;

(c) Removal and exclusion of the respondent from the residence

of the petitioner, regardless of ownership of the residence,
either temporarily for the purpose of protecting the petitioner,
or permanently where no property rights are violated, and if
respondent must remove personal effects from the residence,
the court shall direct a law enforcement agent to accompany the
respondent has gathered his things and escort respondent from
the residence;

(d) Directing the respondent to stay away from petitioner and

designated family or household member at a distance specified
by the court, and to stay away from the residence, school, place
of employment, or any specified place frequented by the
petitioner and any designated family or household member;

(e) Directing lawful possession and use by petitioner of an

automobile and other essential personal effects, regardless of
ownership, and directing the appropriate law enforcement
officer to accompany the petitioner to the residence of the
parties to ensure that the petitioner is safely restored to the
possession of the automobile and other essential personal
effects, or to supervise the petitioner’s or respondent’s removal
of personal belongings;

(f) Granting a temporary or permanent custody of a

child/children to the petitioner;

(g) Directing the respondent to provide support to the woman

and/or her child if entitled to legal support. Notwithstanding
other laws to the contrary, the court shall order an appropriate
percentage of the income or salary of the respondent to be
withheld regularly by the respondent’s employer for the same to
be automatically remitted directly to the woman. Failure to
remit and/or withhold or any delay in the remittance of support
to the woman and/or her child without justifiable cause shall
 render the respondent or his employer liable for indirect
contempt of court;

(h) Prohibition of the respondent from any use or possession of

any firearm or deadly weapon and order him to surrender the
same to the court for appropriate disposition by the court,
including revocation of license and disqualification to apply for
any license to use or possess a firearm. If the offender is a law
enforcement agent, the court shall order the offender to
surrender his firearm and shall direct the appropriate authority
to investigate on the offender and take appropriate action on
matter;

(i) Restitution for actual damages caused by the violence

inflicted, including, but not limited to, property damage,
medical expenses, childcare expenses and loss of income;

(j) Directing the DSWD or any appropriate agency to provide

petitioner may need; and

(k) Provision of such other forms of relief as the court deems

necessary to protect and provide for the safety of the petitioner
and any designated family or household member, provided
petitioner and any designated family or household member
consents to such relief.

Any of the reliefs provided under this section shall be granted

even in the absence of a decree of legal separation or annulment
or declaration of absolute nullity of marriage.

The issuance of a BPO or the pendency of an application for

BPO shall not preclude a petitioner from applying for, or the
court from granting a TPO or PPO.

16. All told, there is an urgent need to issue and order directed to the defendant
directing him to refrain from going near petitioner’s house and committing
acts of violence as provided under Section 5 of R.A. 9262 which causes
undue physical, emotional or psychological harm on petitioner and her
children.

17. The Barangay Protection Order expired on ____________.

 PRAYER

WHEREFORE, above premises considered, it is respectfully prayed that:

1. An ex parte temporary protection order be issued by the Honorable

Court:

a. Prohibiting Respondent from threatening to commit or

committing, personally or through another any of the acts of
violence against women and children as provided any of the acts
mentioned in Sec. 5 of R.A. 9262;

b. To prohibit the Respondent from harassing, annoying,

telephoning, contacting or otherwise communicating with the
petitioner directly or indirectly;

c. Removal and exclusion of the respondent from the residence of

the Petitioner, regardless of ownership of the residence, either
temporarily for the purpose of protecting the Petitioner, or
permanently where no property rights are violated, and if
Respondent must remove personal effects from the residence, the
court shall direct a law enforcement agent to accompany the
respondent has gathered his things and escort respondent from the
residence.

d. To direct the Respondent to stay away from herein Petitioner and

designated family or household member at a distance specified by
the court, and to stay away from the residence, and place of
employment, or any specified place frequented by the petitioner
and any designated family or household member.

e. Directing the Respondent to provide support to the Petitioner

and her children;.
 f. Prohibition of the Respondent from bringing his government
issued firearm when allowed by this Court to visit his children.

2. To make the protection order PERMANENT upon due notice and

hearing one (1) day prior to the expiration of the TPO.

Other forms of relief as the court may deem necessary to protect and
provide for the safety of petitioner and her children under the foregoing
circumstances are likewise prayed for.

RESPECTFULLY SUBMITTED. __________

Dumaguete City, Philippines.
 VERIFICATION AND CERTIFICATION
OF NON-FORUM SHOPPING

I, IRYNN BENARAO OLASIMAN, of legal age, Filipino, working as a

Jail Officer assigned at BJMP Provincial office and a resident of Barangay Lower
Cadawinonan, Dumaguete City.

1. I am the Petitioner in this case;

2. I have caused the preparation of this PETITION FOR THE ISSUANCE

OF AN EX PARTE TEMPORARY PROTECTION ORDER AND
PERMANENT PROTECTION ORDER;

3. I have read the foregoing pleading, the contents of which are true and correct
based on my personal knowledge and authentic records at hand;

4. No other action or proceeding involving the same issues raised in the

Petition has been commenced in any court, tribunal or quasi-judicial agency,
and to the best of my knowledge, no such action or proceedings is pending
therein;

5. Should I hereafter learn that a similar action or proceeding has been filed or
is pending before any court, tribunal or quasi-judicial agency, I undertake to
promptly inform this Honorable Court of such fact within five (5) days
therefrom.

IN WITNESS WHEREOF, I hereunto affix my signature this ___ day of

August 2020, at Dumaguete City, Philippines.

IRYNN BENARAO OLASIMAN

Petitioner
Type of I.D.: _________
I.D. No.: _________________

SUBSCRIBED AND SWORN to before me this ___ day of August 2020 at

Dumaguete City, affiant exhibiting to me her valid I.D. shown below her name, as
competent proof of identity.
Doc. No.:____
Page No.:____
Book No.:____
Series of 2020.
Copy furnished by personal service: