Affidavit for Preliminary Attachment

(Caption and title of case)

AFFIDAVIT
REPUBLIC OF THE PHILIPPINES
PROVINCE OF _________________
MUNICIPALITY OF_____________

SS

I, __________________________________ , of legal age, single / married, and resident

of ____________________________________________ after being sworn in
accordance with law, depose and say:
1. That I am the plaintiff in the above entitled case;
2. That on ______________________, 20__, defendant executed and signed the
following promissory note (see attached document), to wit:
I, _________________________________, hereby obligate myself to
pay ________________________________________________ the sum
of ___________________________________________ (P _____) on or
before ____________________, 20_____ .
3. That a sufficient cause of action exists against the defendant named therein;
4. That the aforementioned obligation of defendant is now overdue and the said
defendant failed and refused to pay in part or in whole his obligation.
5. That this action is one of those specifically mention in Sec. 1 of Rule 57 of the
Rules of Court, whereby a writ for preliminary attachment may lawfully issue; namely:
___________state the nature of the suit__________________________________
___________please see below_________________________________________
Rule 57, Section 1. Grounds upon which attachment may issue.
At the commencement of the action or at any time before entry of
judgment, a plaintiff or any proper party may have the property of the
adverse party attached as security for the satisfaction of any judgment
that may be recovered in the following cases:
(a) In an action for the recovery of a specified amount of money or
damages, other than moral and exemplary, on a cause of action arising
from law, contract, quasi-contract, delict or quasi-delict against a party
who is about to depart from the Philippines which intent to defraud his
creditors;
(b) In an action for money or property embezzled or fraudulently
misapplied or converted to his own use by a public officer, or an officer of
a corporation, or an attorney, factor, broker agent, or clerk, in the course
of his employment as such, or by other person in a fiduciary capacity, or
for a willful violation of duty;

(c) In an action to recover the possession of property unjustly or

fraudulently taken, detained or converted, when the property, or any part
thereof, has been concealed, removed, or disposed of to prevent its being
found or taken by the applicant or an authorized person;
(d) In an action against a party who has been guilty of a fraud in
contracting the debt or incurring the obligation upon which the action is
brought, or in the performance thereof;
(e) In an action against a party who has removed or disposed of his
property, or is about to do so, with intent to defraud his creditors; or
(f) In an action against a party who does not reside and is not found in the
Philippines, or on whom summons may be served by publication.
6. That said defendant is about to leave the country with the intent to defraud his
creditors.
7. That there is no sufficient security for the claim sought to be enforced by this
action;
WHEREFORE, plaintiff prays that:
1. The defendant be ordered to pay the plaintiff the amount of
___________________________, (P ________) with ___ % interest per annum from the
date this complaint is filed.
2. A Writ of Attachment be immediately issued against property of defendant, as
security for the satisfaction of any judgement that may be recovered.
__________(place)________________ this ____day of _____________ , 20 ___.
__________________
(Plaintiff)
(JURAT)
SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for
_________(City/Province)____________ this ____th day of ____________ 20___.
Affiant personally came and appeared with _____________(Competent Evidence of
Identity)______ issued by the _________(Government Agency)______ on ___(date)__
at ________(place)_________, bearing his photograph and signature, known to me as the
same person who personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of said instrument.

Doc. No. 123

Page No. 69
Book No. VII
Series of 2007

ATTY _________________________________
COMMISSION NO. _____________________
NOTARY PUBLIC for _____________________
UNTIL DECEMBER 31, 200_
OFFICE: _____________________
ROLL NO. 00001
IBP Lifetime Roll No. 1234567 ; 01/07/07 ; ________
PTR NO 1234567 ; 01/07/07 ; ________
MCLE COMPLIANCE No. __________; July 7, 2007