Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
PERSEVIRANDA CRUZ
MENDOZA, doing business
in the name and style of
CMCM FEEDS SUPPLY &
VETERINARY CENTER,
Plaintif,
STATEMENT OF CLAIM
1. The personal circumstances of the parties are as follows:
COOPERATIVE SOLE
PROPRIETORSHIP
Zip Code
(Province, if applicable) Bulacan
3022 ;
Zip Code
COOPERATIVE SOLE
PROPRIETORSHIP
HOME ADDRESS: (City) Kamandalaan, San Jose del Monte City 3024
Zip Code
(Province, if applicable) Bulacan
3024
Zip Code
(c) How did you compute the money owed to you? (Do not
include court costs or fees) The Sales Invoice issued by the
Plaintiff, signed by the Defendant.
3. (a) Did you ask the defendant to pay you before you
filed this case?
Yes No
If no, explain:___________________________________________________________
In person By phone
4. What is your proof that defendant owes you money? The Sales
Invoice issued by the Plaintiff, signed by the Defendant.
Yes No
State reason:
The parties live in
different municipalities
6-A- In this court station, how many small claims cases have
you filed within this calendar year prior to this present case? 1
PRAYER
PERSEVIRANDA C. MENDOZA
PLAINTIFF
REPUBLIC OF THE PHILIPPINES }
City of Meycauayan } S.S.
AFFIDAVIT