FORM 3-SCC
Republic of the Philippines
____________ Judicial Region
________________ TRIAL COURT
Branch _____, _____________, _____________
______________________,
Plaintiff,
-versus-
______________________,
Defendant.
x - - - - - - - - - - - - - - - - - - - - - - - - -x
CIVIL CASE NO. _______________
FOR: _________________
Defendant/s state/s:
(Ang Hinahabla ay nagsasaad:)
1. Defendant denies the Statement of Claim for any of the following reasons: (Put a check in any of the following)
(Tinatanggihan ng Hinahabla ang Habla ng Pagsingil sa alinmang sumusunod na dahilan): [Pumili sa mga sumusunod at lagyan ng tsek]
(a) ____ Defendant does not owe plaintiff any money.
(Ang Hinahabla ay walang pagkakautang na salapi sa Naghahabla.)
____ Defendant owes plaintiff only a portion of the amount claimed.
(Ang utang ng Hinahabla ay bahagi lamang ng halagang sinisingil ng Naghahabla.)
____ It is the plaintiff who owes defendant money.
(Ang Naghahabla ang siyang may utang na salapi sa Hinahabla.)
(b) If defendant owes plaintiff only a portion of the amount claimed, how much is this?
(Kung ang utang ng Hinahabla ay bahagi lamang ng halagang sinisingil ng Naghahabla, magkano ito?)
_________________________________________________.
_________________________________________________.
(c) If it is the plaintiff who owes defendant money, how much and when did this happen?
(Kung ang Naghahabla ang siyang may utang na salapi sa Hinahabla, magkano at kailan ito nangyari?)
_________________________________________________.
_________________________________________________.
If no specific date, estimate the time period:
(Kung walang tiyak na petsa, ibigay ang tantiyang panahon)
Date started (Petsa nagsimula) _______________
Through (Hanggang)__________________
(d) How did you compute the money owed you? (Do not include court costs or fees for service.)
(Paano mo kinuwenta ang salaping pagkakautang sa iyo?) (Huwag isama ang filing fees at bayad sa serbisyo.)
_________________________________________________.
_________________________________________________.
2. If plaintiff owes you money, did you ask plaintiff to pay you?
(Kung ang Naghahabla ay siyang may pagkakautang sa iyo, siningil mo ba siya?)
_____ Yes (Oo) _____ No (Hindi)
If yes, how? (Kung oo, paano?)
____ In person (Sa kanya mismo) ____ Others (specify) (Iba pa) [ano ito?] ___________
____ In writing (Sa sulat)
____ By phone (Sa telepono)
3. Do you have any proof? _____Yes _____No
(Meron ka bang anumang katibayan?) (Oo) (Hindi)
What is this proof? (Anong katibayan ito?)
_____ Receipt (Resibo)
_____ Other document (Iba pang dokumento)
_____ Witness (Saksi/testigo)
4. As the Statement of Claim is baseless, defendant is entitled to the following counterclaims:
(Sa dahilang walang basehan ang Habla ng Pagsingil, ang Hinahabla ay may karapatan sa mga ganting-habol na sumusunod)
____ Actual Damages for the value of the loss suffered by the filing of the case P _______________.
(Bayad para sa aktwal na pinsalang idinulot ng pagsampa ng kaso)
____ Costs of suit for the money defendant spent in filing a countercharge against plaintiff P ________________.
(Kabayaran/Gastos sa kasong isinampa)
________________________________________________
DEFENDANT
(Hinahabla)