Sie sind auf Seite 1von 5

REPUBLIC OF THE PHILIPPINES

REGIONAL TRIAL COURT


(REGION WHERE THE PLAINTIFF RESIDES)
BRANCH ___
(CITY OR PROVINCE WHERE THE PLAINTIFF RESIDES)

NAME OF PLAINTIFF, Plaintiff, CIVIL CASE No.____________

-versus- FOR: Damages for death, Loss of


earning capacity , Moral Damages and
Attorney’s Fees

2GO SHIPPING LINES and M/V


SULPICIO EXPRESS SIETE
x----------------------------------------------------------------------------------------------------------x

COMPLAINT
COMES NOW, plaintiff __________________, by counsel, and unto this
Honorable Court, most respectfully avers THAT:

1. Plaintiff, __________________________, is a Filipino, of legal age,


married/single and residing at ____________________________________, where
he may be served with summons, papers and other process of this Honorable
Court;

2. That defendant 2GO Shipping Lines is the owner of M/V Saint Thomas
Aquinas, duly organized under the Philippines law, engaged in the doing business
as a passenger vessel, wherein its principal place of business is located at
________________ where it may be served summons; while M/V Sulpicio Express
Siete (same with 2GO format);

3. That on or about _____________________, defendant 2GO Shipping


Lines’ vessel, M/V Saint Thomas Aquinas, collided with defendant M/V Sulpicio
Express Siete;
4. (allege facts with all the elements of breach of contract of common
carrier and/or elements of negligence for torts)

4. That due to the negligence of the defendants, the vessels collided and
sank, which resulted to the death of many passengers including plaintiff’s daughter;

5. That by reason thereof, the plaintiff ______ suffered not only physical
injuries for which she was medically treated but also mental anguish, serious
anxiety, and moral shock;

6. That plaintiff suffered actual damages for medical attendance, etc., in


the sum of ______________________ and moral damages in the sum of FIVE
HUNDRED THOSAND PESOS (P500,000.00);

7. Due to the sudden death of _________, her parents and siblings


suffered mental anguish and serious anxiety.

8. That because of plaintiff’s daughter’s death, she incurred funeral


expenses in the amount of ONE HUNDRED THOUSAND PESOS (P100,000.00);

9. Consequently, Plaintiff was constrained to engage the services of


counsel to whom it obligated itself to pay as Attorney's Fees the amount equivalent
to TWENTY FIVE PERCENT (25%) of the total amount to be adjudged in favor of
plaintiffs, and the costs of this suit.

WHEREFORE, the above premises considered, it is respectfully prayed of this


Honorable Court after hearing on the merits, that:

a. Defendants be ordered to pay for actual damages for medical


attendance and funeral expenses;

b. Defendants be ordered to pay for damages for death in the amount of


FIFTY THOUSAND PESOS.

c. Defendants be ordered to pay moral damages in the amount of FIVE


HUNDRED THOUSAND PESOS (Php 500,000.00);
d. Defendants be ordered to pay attorney’s fees in an amount equivalent
to TWENTY FIVE PERCENT (25%) of the total amount to be adjudged in
favor of plaintiffs;

e. Defendants be ordered to pay the costs of this suit.

Other reliefs just and equitable under the premises are likewise prayed for.

____(MM DD, YYYY) date when complaint was made)___, (City/Province).

___________(Signature)_________
Name of Plaintiff
Plaintiff

Assisted by:

PUBLIC ATTORNEY’S OFFICE


East Wing, Feman Hall Of Justice
Capitol Compound Road, Cebu City, 6000 Cebu

By:

______________________________
(NAME OF ATTORNEY FOR PLAINTIFF)
Public Attorney II
IBP No. AR001147/01-08-18/Q.C.
Roll No. 59364
MCLE Compliance No. V-0005461 Jan. 13, 2015

Copy Furnish
DE BORJA LAMORENA & DUANO LAW OFFICES
Counsel for Defendant
Unit 2502-A East Tower, Philippine Stock Exchange Center,
Exchange Road, Ortigas Center, Pasig City
VERIFICATION AND CERTIFICATION OF NON-FORUM SHOPPING
I, _______________________, of legal age, single/married after having been duly
sworn in accordance with law, depose and state that:
1. I am a plaintiff in the above-stated case;
2. I caused the preparation of the foregoing complaint;
3. I have read the contents thereof and the facts stated therein are true and
correct of my personal knowledge and/or on the basis of copies of
documents and records in my possession;
4. I have not commenced any other action or proceeding involving the same
issues in the Supreme Court, the Court of Appeals, or any other tribunal or
agency;
5. To the best of my knowledge and belief, no such action or proceeding is
pending in the Supreme Court, the Court of Appeals, or any other tribunal or
agency;
6. If I should thereafter learn that a similar action or proceeding has been filed
or is pending before the Supreme Court, the Court of Appeals, or any other
tribunal or agency, I undertake to report that fact within five (5) days
therefrom to this Honorable Court.

___________________________
Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of October 2018,


affiant exhibiting to me his SSS ID No. 1234321 issued on October 1, 2018 at Cebu
City.

Doc. No. 123;


Page No. 321;
Book No. IV;
Series of 2018.