HLURB Case Form No.

03(2)

Republic of the Philippines

Office of the President of the Philippines
HOUSING AND LAND USE REGULATORY BOARD
Northern Tagalog Regional Field Office
3rd Floor Insular Life Bldg., McArthur Highway
Barangay Dolores, City of San Fernando
Pampanga

____________________________________,
Complainant,

-v e r s u s- HLURB CASE NO. ___________________________

_____________________________________
Respondent,
x-------------------------------------------------------------------------------------------------------------------------x

ANSWER
RESPONDENT __________________________________________, respectfully allege:

1. Admissions and Denials

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__________________________________________________________________________________________________________
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(Note: If more space needed, write at the back of this page and countersign)

2. The facts are as follows: (chronological)

Date Events
______________ : ______________________________________________________________________________________________
______________ : ______________________________________________________________________________________________
______________ : ______________________________________________________________________________________________
______________ : ______________________________________________________________________________________________
______________ : ______________________________________________________________________________________________
(Note: If more space needed, write at the back of this page and countersign)

3. In support of the foregoing fact s and circumstances, the following documents and affidavits are herewith
attached:

Annex Letter Description of Document Purpose of Document

(Note: If more space needed, write at the back of this page and countersign)

4. Respondents is entitled to the dismissal of the complaint based on the following defenses:

__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
(Note: If more space needed, write at the back of this page and countersign)
 HLURB Case Form No. 03(2)

5. As the complaint is baseless, the respondent is entitled to the following reliefs:

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__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
(Note: If more space needed, write at the back of this page and countersign)

Damages (please check): Actual/Compensation P _____________________ Moral P_____________

Exemplary P _____________________ Attorney’s Fee P ______________
Others ____________________________________ P _________________________

Provisional Remedies: ______________________________________________________________________________

______________________________________________________________________________

______________________________, for City of San Fernando, Pampanga. _________________. (date signed)

_____________________________
Respondent

VERIFICATION
I, __________________________________ , of legal age, Filipino, and a resident of ____________________________ on
oath state that:

1. I have not commenced any action or proceeding involving the same issue or subject matter in
the Supreme Court, the Court of Appeals or any other tribunal or agency;
2. to the best of my knowledge, such as action or proceeding is pending in the Supreme Court, the
Court of Appeals or any other tribunal or agency
3. if I should learn thereafter that a similar action or proceeding has been filed or is pending ,
before these courts or tribunal or agency, I undertake to report that fact to the Honorable Office
within five (5) days therefrom.
_____________________________________
Respondent-Counterclaim/Crossclaimant/
Third-Party Complaint, etc.

Republic of the Philippines }

City of San Fernando, Pampanga } S.S.
x---------------------------------------x

SUBSCRIBED AND SWORN to before with this ____ day of March, 2018 in the City of San
Fernando, Pampanga affiant exhibiting to me her ID No. _______________ issued on __________________ at
_______________________.

WITNESS MY HAND AND SEAL, on the date and at the place first above-written.

Notary Public
Doc No. __________
Page No. _________
Book No. ________
Series of ____________