FORM 5-A-SCC

Republic of the Philippines

____________ Judicial Region

________________ TRIAL COURT

Branch _____, _____________, _____________

PLAINTIFF’S RETURN / MANIFESTATION

This is to certify that on (date) and (date) , the undersigned tried to serve the Summons, Statement of Claim, together with the Annexes and Notice of Hearing upon the defendant/s name/s of defendant/s , but failed and unavailing on the ground that the said defendant/s was/were not around during the time of service.

However, on (date) , the Summons, Statement of Claims, Annexes thereto and Notice of Hearing were served through (name of person who received) , who introduced himself/herself as a (relationship of the person to the defendant/s) , a person of suitable age and discretion, residing therein, who signed at the lower portion of the summons.

Substituted service was made after the undersigned exerted earnest efforts to serve the Summons, together with the Statement of Claim, Annexes thereto and the Notice of Hearing personally upon the defendant, which proved futile.

WHEREFORE, the original copy of the Summons is respectfully returned to the Honorable Court, DULY SERVED.

_________________________, Philippines, (date).

___________________________

Plaintiff