FORM 5-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 personally to (name of defendant who received) , as shown by her/his signature appearing at the lower portion of the summons.

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

_________________________, Philippines, (date).

___________________________

Plaintiff