REPUBLIC OF THE PHILIPPINES

[Region]
REGIONAL TRIAL COURT
[Branch No.], [City]

The petition for legal separation shall be filed in the Family

Court of the province or city where the petitioner or the
respondent has been residing for at least six months prior to
the date of filing or, in rhe case of a non-resident respondent,
where he may be found in the Philippines, at the election of
the petitioner. [Sec 2 (c), Rule on Legal Separation, A.M. No.
02-11-11-SC]

[NAME] _____________________,
Petitioner.

-versus- SP No. __________

[NAME] _____________________,
Respondent.

A petition for legal separation may be filed only by the

husband or the wife. [Sec 2 (a), Rule on Legal Separation, A.M.
No. 02-11-11-SC]

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

PETITION FOR LEGAL SEPARATION

PETITIONER, by counsel, respectfully states that:

1. Petitioner is a Filipino citizen, of legal age and married to respondent.

For purposes of this petition, she may be served with notices and other
pertinent processes through counsel at [Address of counsel].

2. Respondent is a Filipino citizen, of legal age, currently employed at

[Name of employer] and married to petitioner. He may be served with summons
and other pertinent orders and processes of this Court at [State address].

3. Petitioner and respondent were married on [Date] in [Place]. A copy of

the Marriage Contract executed by petitioner and respondent is attached as
ANNEX A.

4. Out of the union, petitioner and respondent begot [state number]

children, [state name and respective ages of children]. A copy each of the birth
certificates of the minor children is attached as ANNEX B, C and D, respectively.

5. During the marriage, petitioner and respondent acquired several

properties through their joint efforts, namely: [insert description of properties].
[Indicate also which, if any, of the above properties is being used as the family
home].

6. Petitioner and respondent are currently separated in fact and have

been so since [state month and year]. The reason for the continuing separation
in fact is the breakdown of the marriage due to [state ground/s for seeking legal
separation, and insert factual circumstances to support the ground/s invoked].

A petition for legal separation may be filed only within five years from
the time of the occurrence of any of the following causes:

(a) Repeated physical violence or grossly abusive conduct directed

against the petitioner, a common child, or a child of the petitioner;
(b) Physical violence or moral pressure to compel the petitioner to
change religious or political affiliation;
(c) Attempt of respondent to corrupt or induce the petitioner, a
common child, or a child of the petitioner, to engage in prostitution,
or connivance in such corruption or inducement;
(d) Final judgment sentencing the respondent to imprisonment of
more than six years, even if pardoned;
(e) Drug addiction or habitual alcoholism of the respondent;
(f) Lesbianism or homosexuality of the respondent;
(g) Contracting by the respondent of a subsequent bigamous
marriage, whether in or outside the Philippines
(h) Sexual infidelity or perversion of the respondent;
(i) Attempt on the life of petitioner by the respondent; or
(j) Abandonment of petitioner by respondent without justifiable cause
for more than one year.
[Sec 2 (a), Rule on Legal Separation, A.M. No. 02-11-11-SC]

7. Respondent is gainfully employed as [state job position] at [Name of

Employer] and earning an annual/monthly salary of [Php _______]. [state also if
respondent has additional sources of income from a separate business, stock trading,
rental income from separate properties, etc.] Respondent is well able to provide
financial support for the benefit of the common children he has with petitioner.

WHEREFORE, petitioner respectfully prays that PROVISIONAL ORDERS

for [Child Custody, Support Pendente Lite, Etc.] be issued and respondent be
directed to give monthly support in the amount of [state amount], subject to any
adjustments that may be made based on changing earning capacity as well as
needs.

Petitioner also prays that, after trial, judgment be rendered --

[1] Declaring a decree of legal separation between petitioner and

respondents; and

[2] Ordering the liquidation of the conjugal properties; and

 [3] Awarding permanent custody of the children to petitioner, with
express acknowledgement of respondents visitation rights; and

[4] Awarding monthly support in the amount of [state amount] in favor of

petitioner subject to adjustments to be made depending on changes in
earning capacity and needs of the children.

All other just and equitable reliefs are also prayed for.

[City], [Date].

[SIGNATURE]
[Name of Counsel]
Counsel for _________
[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 petitioner in the

pleading/document entitled [Petition for Legal Separation] and in such capacity,
caused this pleading 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]

NOTE:

The petition shall be filed in six copies.

The petitioner shall, within five days from such filing, furnish a copy of the petition for
legal separation to the City or Provincial Prosecutor and the creditors, if any, and submit
to the court proof of such service within the same period. [Sec 2 (b)(4), Rule on Legal
Separation, A.M. No. 02-11-11-SC]
 PROOF OF SERVICE

[USE THE FOLLOWING IF SERVICE IS MADE PERSONALLY]

Copy furnished through personal service:

[Name of Counsel] __________________

Counsel for the Plaintiff/Respondent
[Firm Name] _______________
[Address] ________________

AFFIDAVIT

Republic of the Philippines )

City of _______________ ) s.s.

I, [Name] _____ , of legal age and having been duly sworn, depose and
state that:

I am the messenger of [Name of Counsel or Law Firm] with office address

at [Address] __________________, counsel on record for __________ in the case
entitled _____ [Case Title] ___, Civil Case No ________, G.R. No. ______, and as
such messenger, I served upon the counsel of adverse party and other parties,
the petition (or motion or other pleading) filed in said case as follows:

___[Name of Counsel or Law Firm]__, counsel of record for __

[Respondent] ___, by personal service by delivering personally copy of said the
petition (or motion or other pleading) upon said lawyer, who acknowledged
receipt thereof [or who acknowledged the same though his receiving secretary]
as shown by his signature or initials on said pleading, this __ [Date]__, 20___.

Note: if no person is found in his office, or if his office is not known, or he

has no office, then service is made by leaving a copy, between the hours of eight
in the morning and six in the evening, at the partys or counsels residence, if
known, with a person of sufficient age and discretion then residing therein.

TO THE TRUTH OF THE FOREGOING, I have signed this Affidavit on

[DATE] ________________, in the City of [CITY] _____________, Philippines.

[Signature]
[Name] _________________
Affiant

[USE THE FOLLOWING IF SERVICE IS NOT MADE PERSONALLY]

Copy furnished through registered mail:

[Name of Counsel] __________________

Counsel for the Respondent/Plaintiff
[Firm Name] _______________
[Address] ________________
Registry Receipt No. ________
Post Office ________________
Date _____________________

EXPLANATION

The foregoing Petition for Review and its attachment were served on
[Name of Counsel] ________________ by registered mail instead of personal
service as counsel for Respondent for the reason that [state reason]
___________________.

[Signature]
[Name] _________________

AFFIDAVIT

Republic of the Philippines )

City of _______________ ) s.s.

I, [Name] _____ , a messenger of [Name of Counsel], with office address at

[Address] __________________, after being duly sworn, deposes and states:

That on [Date] ______________________, I served a copy of the following

pleadings/papers by registered mail in accordance with Section 10, Rule 13 of
the Rules of Court:

Nature of Pleading/Paper
[STATE PLEADING/PAPER SENT]
________________________

in Case No. [CASE NUMBER] _________________ entitled [TITLE OF CASE]

____________________ by depositing a copy in the post office in a sealed envelope,
plainly addressed to [NAME OF PARTY/ATTORNEY] _______________ at
_______________ with postage fully paid, as evidenced by Registry Receipt No.
_____________________ attached and with instructions to the post master to
return the mail to sender after ten (10) days if undelivered.

TO THE TRUTH OF THE FOREGOING, I have signed this Affidavit on

[DATE] ________________, in the City of [CITY] _____________, Philippines.
 [Signature]
[Name] _________________
Affiant

SUBSCRIBED AND SWORN TO before me in the City of _______________

on this _______ day of [Month], 20____, affiant exhibiting before me his
Government Issued ID No. _______________ issued on [Date]__________________ 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 20 _____.