COMPLAINT

COMES NOW the plaintiffs, by their undersigned counsel, and unto this
Honorable Court, respectfully alleges:
1. That plaintiff ______name of plaintiff #1_____________ is of legal age,
married and a resident of ____________________________________; while the plaintiff
_______ name of plaintiff #2_________ is also of legal age, married and a resident of
____________________________________;
2. That defendant ____________________ is a corporation duly organized under
Philippine law, engaged in the business of manufacturing household appliances, with
principal office at Php_________________________, while the other defendant
____________________ is the driver of the corporation's delivery truck, and both may be
served with summons at said address;
3. That for cause of action against the defendants, it is hereby stated that on or
about _______date_________, at about ______ o'clock in the morning while driver
________________ was driving the company's delivery truck, bearing plate No. ZTE200 along Naguillan Road, within the territorial jurisdiction of Baguio City, he so
negligently and recklessly drove the delivery truck at a very fast speed in disregard of
traffic conditions then existing that he caused it to bump with terrific force a Pink
Cadillac, bearing plate No. AAV-777, in which plaintiffs are riding as passengers;
4. That because of the terrific impact, the said Pink Cadillac was considerably
damaged not only in the rear portion but also in front or radiator portion, having been
pushed several meters forward against other vehicles in front due to said strong impact;
5. That because of the gross negligence of driver ________________, an
employee of defendant ________________ and the plaintiffs were thrown off balance,
causing them especially plaintiff ________________ to bump his head and face against
the front windshield of the car he was in, and causing contusions and bruises on his face,
left earlobe and leg, as well as in other parts of his body;
6. That by reason thereof, the plaintiff ________________ suffered not only
physical injuries for which he was medically treated but also mental anguish, fright,
serious anxiety and moral shock;
7. That plaintiff ________________ had suffered actual damages for X-rays and
medical assistance in a sum of Php______________ and moral damages in a sum of
Php______________;
8. That plaintiff ________________ suffered physical injuries which did not
require medical attendance, however, the Pink Cadillac owned and driven by him was
badly damaged and will require substantial repairs estimated to be
____________________________________ Pesos (Php__________);
9. That plaintiff _______________________, by reason of having been deprived
of the use of his own car during the period of the repairs, estimated to be three (3)
months, will be forced to rent a car in going to and from his office in Baguio at the rate of
not less than _____________________________ Pesos (Php_____ ) a day, or an
estimated actual damage of _______________________ Pesos (Php_______ ) for the
duration of the repairs;

10. That plaintiff ________________, by reason also of having been deprived of

the use of his private car, is missing important business contracts which will cause him
loss of income to the extent of P________________for the duration of the repairs;
11. That prior to the filing of this complaint, the plaintiffs through counsel, had
written to defendant ________________ Corporation that as employer of the defendant
________________, it is its legal obligation under the law to make good at least the
actual damages suffered by the plaintiffs, but said employer ignored plaintiff's request for
an extrajudicial settlement, such that the plaintiffs were compelled to go to court for
redress of their grievances;
12. That in being compelled to litigate, plaintiffs were obliged to engage the
services of a lawyer who is entitled to attorney's fees in an amount of
_______________________________________ Pesos (Php______________);
WHEREFORE, plaintiffs through undersigned counsel, pray this Honorable
Court, after due hearing, to adjudge defendants ________________ Corporation and
________________, jointly and severally, to pay the following:
(a) To ________________:
(1) Actual damages of Php______________
(2) Moral damages of Php______________
(3) Attorney's fees of Php______________
(b) To ________________:
(1) Actual damages of Php______________;
(2) Loss of Income of Php______________;
(3) Attorney's fees of Php______________;
OR total damages for both plaintiffs in the sum of Php_____________, with legal
interest from the date of filing this suit, plus costs of the suit, and such other remedies as
may be just and equitable in the premises.
Agoo, La Union, _________________, 20___.

_________________
Counsel for Plaintiffs
_____Address_______________
_____IBP No._______________
_____Roll No._______________
_____MCLE Compliance No.___

VERIFICATION & JURAT