Republic of the Philippines

____________ Judicial Region

________________ TRIAL COURT

Branch _____, _____________, _____________

RECORD ON APPEAL

BE IT REMEMEBERED, that on the dates herein respectively mentioned, the following proceedings were had in the Regional Trial Court of __________________:

1. That on _____________, the plaintiff-appellee filed a complaint against the defendant-appellant, in the following:(Copy complaint)

2. That_______________, the defendant-appellant filed his Answer to said complaint, as follows: (Copy complaint)

3. That after due hearing, the court, on ______________rendered the following decision: (Copy Decision)

4. That on______________, defendant-appellant filed a motion for reconsideration of the following tenor: (Copy Motion for reconsideration)

5. That on _______________, the court issued an order denying the said motion for reconsideration, to wit:

6. That on_____________, defendant-appellant received notice of the said order denying his motion for reconsideration, and on ___________ filed his Notice of Appeal to the Court of Appeals as follows: (Copy notice of appeal)

WHEREFORE, the defendant-appellant prays for the approval of this Record on Appeal and that the same be transmitted to the Court of Appeal, together with all the oral and documentary evidence give and presented at the trial of the above-entitled case.

ATTY. ________________________

Counsel for the Plaintiff

[Address]

Roll of Attorney No. __________

IBP No. __________/__________/__________

PTR No. __________/__________/__________

Copy furnished:

ATTY. ______________________________

[Address]