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Template K-Complaint (Bullying)

This document is a template for filing a complaint regarding bullying in a school setting, including sections for the complainant's details, a narration of facts, and a certification against forum shopping. It requires the complainant to affirm that no similar claims have been filed elsewhere. The document also includes a section for a school head to notarize the affidavit.

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Astria Athena A. Araneta
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119 views1 page

Template K-Complaint (Bullying)

This document is a template for filing a complaint regarding bullying in a school setting, including sections for the complainant's details, a narration of facts, and a certification against forum shopping. It requires the complainant to affirm that no similar claims have been filed elsewhere. The document also includes a section for a school head to notarize the affidavit.

Uploaded by

Astria Athena A. Araneta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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INSERT

SCHOOL
LOGO HERE

Template “K”
(NAME OF COMPLAINANT),
Complainant,

-versus- AB Case No. _______

(NAME OF BULLY),
Person-complained-of.

X - - - - - X

COMPLAINT

I, (NAME OF COMPLAINANT-Parent), of legal age, married, and a resident of


(HOME ADDRESS), mother/father of (NAME OF THE STUDENT, PUPIL or LEARNER)
after having been sworn to in accordance with law, depose and say:

1. (Narration of facts) ______________________________________________________


2. ______________________________________________________
3. ______________________________________________________

IN WITNESS WHEREOF, I hereunto have set my hand this ____ day of _______ 2020
at _________________________.

NAME OF PARENT
(Valid government issued ID)

CERTIFICATION AGAINST FORUM SHOPPING

I, (NAME OF COMPLAINANT-Parent), of legal age, married, and a resident of


(HOME ADDRESS), mother/father of (NAME OF THE STUDENT, PUPIL or LEARNER)
after having been sworn to in accordance with law, depose and say:

That I have not filed any action or filed any claim involving the same issue/s in
any court, tribunal or quasi-judicial agency, and to the best of my knowledge, no such
other action or claim is pending therein; and if there is such other pending action or
claim, a complete statement of the present status thereof; and should I thereafter learn
that the same action or claim has been filed or is pending, I shall report that fact within
five (5) days to the Honorable Office.

IN WITNESS WHEREOF, I hereunto have set my hand this ____ day of _______ 2023
at _________________________.

REPUBLIC OF THE PHILIPPINES )


PROVINCE OF ISABELA )S.S.
MUNICIPALITY OF ___________ )

BEFORE ME, a School Head of NAME OF SCHOOL, at __________________,


Isabela, personally appeared the affiant, personally known to me to be the same person
referred to in the affidavit, exhibiting his/her __________________________, containing
his/her signature and photograph, signing his/her name in the affidavit in my presence
avowing under penalty of law to the whole truth of the contents of the said affidavit.

IN WITNESS WHEREOF, I hereunder have affixed and set my hand and


seal on these presents this ____ day of _______ 2023
at _________________________.
SCHOOL HEAD NAME

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