REPUBLIC OF THE PHILIPPINES

[REGION]
[COURT]
[BRANCH], [CITY]

(Note: Actions for damages and actions to collect a sum of money

must be filed in either the residence of the plaintiff or the residence
of the defendant at the election of the plaintiff.)

[NAME],
Plaintiff,
CIVIL CASE No. ___________

- versus - FOR: DAMAGES BASED ON QUASI

DELICT

[NAME COMMON CARRIER OPERATOR]

and [NAME OF DRIVER],
Defendants.

x ----------------------------------- x

COMPLAINT FOR DAMAGES

PLAINTIFF, by counsel, respectfully states that:

1. Plaintiff is a Filipino, of legal age and resides at [Address] and is

represented herein by the undersigned counsel [or law firm] with office
address at [Address] where plaintiff may be served with pertinent notices
and court processes.

2. Defendant [Name of Common Carrier Operator] is a sole

proprietorship/partnership/corporation, organized under the laws of the
Republic of the Philippine with business address at [Address] while,
[Name of Driver] is a Filipino, of legal age, and resides at [Address].

3. [Describe factual incident leading to the injury]

Ex. On or about 7:30 a.m. of May 5, 20XX, plaintiff was about to cross
the street along [name of street] on her way to work when a [name of bus]
bus with plate no. XXX-XXX being driven by [name of driver] suddenly
speeded up to the street curb and stopped to pick up some passengers in
a no-stop zone. The bus ended up hitting the plaintiff who fell on her
knees due to the force of the impact.

A copy of the police incident report is attached to and made part of this
complaint as Annex “A”.
4. As a result of the recklessness, negligence, and lack of precaution on the
part of the [bus/jeepney/taxi driver], plaintiff suffered injuries on the left
side of her body consisting of bruising on her shoulder and lacerations
on her leg. She had to get medical treatment and incurred expenses in
the amount of Php XXXXX.

A copy of the medical examination report is attached to and made part of

this complaint as Annex “B”. A copy of the hospital receipt and medicine
receipt are likewise attached to and made part of this complaint as
Annex “C” and “D” respectively.

5. As a consequence of her injuries and the shock she suffered from the
incident, plaintiff was unable to go to work from [Date] to [Date], which
led to loss of income for unworked days amounting to [Amount].

A copy of the attendance record of plaintiff during the material time, as

certified by her employer, is attached to and made part of this complaint
as Annex “E”. A copy of the payslip of plaintiff during the material time is
attached to and made part of this complaint as Annex “F”.

6. The [bus/jeep/taxi] being driven by [Name of Driver] at the time of the

incident is owned and/or operated by defendant [Name of Common
Carrier Operator], a common carrier.1

7. Defendant [Name of Driver] is liable to plaintiff, being the principal actor

whose negligence, reckless, and/or unlawful behavior has been the
proximate cause of the injuries and loss suffered by plaintiff.

8. Defendant [Name of Common Carrier Operator] is likewise liable to

plaintiff, being the employer of [Name of Driver], as provided under
Article 2176 in relation Article 2180 of the New Civil Code, to wit:

Article 2176. Whoever by act or omission causes damage to

another, there being fault or negligence, is obliged to pay for the
damage done. Such fault or negligence, if there is no pre-existing
contractual relation between the parties, is called a quasi-delict and
is governed by the provisions of this chapter.

xxx

Article 2180. The obligation imposed by article 2176 is demandable

not only for ones own acts or omissions, but also for those of
persons for whom one is responsible.

1 Common carriers are persons, corporations, firms or associations engaged in the

business of carrying or transporting passengers or goods or both, by land, water, or air,
for compensation, offering their services to the public. [see Article 1732, New Civil Code;
First Philippine Industrial Corp. v. Court of Appeals, G.R. No. 125948. December 29, 1998]
 xxx

Employers shall be liable for the damages caused by their

employees and household helpers acting within the scope of their
assigned tasks, even though the former are not engaged in any
business or industry.

9. The incident and injuries suffered by plaintiff has caused him/her

mental anguish, serious anxiety, moral shock, and other similar injury,
for which defendant/s should be held liable to pay [Amount] as moral
damages.

10. By way of example or correction for the public good, and to deter other
like-minded individuals from trampling upon the rights of others,
defendant/s should be held liable to pay [Amount] as exemplary
damages.

[Note: Exemplary damages are proper only if plaintiff shows his

entitlement to moral, temperate or compensatory damages.]

11. By reason of the negligent act attributable to defendant/s, plaintiff was

compelled to litigate, and for the purpose, engaged the services of the
undersigned law firm for a fee of [Amount] for which defendant/s should
be held liable, including the costs of suit

WHEREFORE, it is respectfully prayed that judgment be rendered ordering

defendant to pay the following sums to plaintiff:

1. [AMOUNT] – for and as actual damages arising from medical expenses

and loss of income
2. [AMOUNT] – for and as moral damages;
3. [AMOUNT] – for and as exemplary damages; and
4. [AMOUNT] – for and as attorney’s fees as well as costs of suit.

[City];[Date].

[Signature]
[Name of Counsel]
Counsel for Plaintiff
[Address]
Roll No. ____________
IBP No. _____________
issued on ________ at _____
PTR No. _____________
issued on ________ at _____
MCLE Compliance _________
 VERIFICATION & CERTIFICATION AGAINST FORUM SHOPPING

I, [NAME] _____________________, of legal age, do hereby state that: I am

the plaintiff in the pleading/document entitled [COMPLAINT FOR DAMAGES]
and in such capacity, caused this Complaint to be prepared; I have read its
contents and affirm that they are true and correct to the best of my own
personal knowledge; I hereby certify that there is no other case commenced or
pending before any court involving the same parties and the same issue and
that, should I learn of such a case, I shall notify the court within five (5) days
from my notice.

IN WITNESS WHEREOF, I have signed this instrument on

[DATE]_____________.

[Signature]
[Name]

SUBSCRIBED AND SWORN TO before me in the City of [Place] on this

day of [Month and Year], affiant exhibiting before me his Government Issued
Identification [ID Type and Number] issued on [Date of Issuance] at [Place of
Issuance].

[Signature]
[Name]
Notary Public
Until [Date]
PTR No. [Number]
Issued at [Place]
On [Date]

Doc. No.
Page No.
Book No.
Series of [Year].