Annex A
Republic of the Philippines
Regional Trial Court
________________
Branch _________
_____________________
IN RE : PETITION FOR INVOLUNTARY COMMITMENT TO THE LOCAL SOCIAL
WELFARE AND DEVELOPMENT OFFICE OF MINOR _________________________
AS AN ABANDONED, NEGLECTED AND DEPENDENT CHILD.
SP. PROC. NO. ________
______________________________________________________________________________
LOCAL SOCIAL WELFARE AND DEVELOPMENT OFFICER
MUNICIPALITY/CITY OF ______________________ PROVINCE OF
____________________________
Petitioner.
x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - x
PETITION
Petitioner unto this Honorable Court most respectfully alleges, THAT:
1. Petitioner is the Local Social Welfare Officer of the Municipality/City of
____________________, province of _____________________;
2. Subject minor ___________________________ is ______________ years old,
presently under care and custody of _____________________.
3. That minor’s case was referred to the herein Petitioner by the
______________________, Branch _______________, for proper disposition
pursuant to its decision dated _______________, copy is hereto attached as
Annex “A” and made an integral part hereof;
4. Per Social Case Study Report conducted and submitted by
___________________________, a Social Worker, of
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____________________________, shows that subject minor has no proper
parental care; his/her parents have deserted him/her for more than six
months; minor’s basic needs have been deliberately unattended by
his/her parents, and there were manifestations showing the subject
minor is a victim of habitual maltreatment by his/her parents; minor’s
parents likewise have failed to comply with the intervention and
prevention programs designed for his/her rehabilitation, copy of the
Social Case Study Report is hereto attached as Annex “B” and made an
integral part here of;
WHEREFORE, premises considered, it is most respectfully prayed of this
Honorable Court that minor _______________________________be declared
abandoned, neglected child, in order that the Local Social Welfare and
Development Office can give consent for his/her permanent placement.
_____________________________________.
___________________________
Petitioner
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VERIFICATION
That I am the Petitioner in the above-entitled case; that I have caused the
preparation and filing of the foregoing Petition for Involuntary Commitment of
minor ____________________ and that the content thereof are true to my
personal knowledge and based on the records and documents submitted.
I further certify that there is no other petition/complaint involving the
same parties, nature and issues pending before the Supreme Court, the Court
of Appeals, Regional Trial Court, the Metropolitan Trial Court, Municipal Trial
Court and other administrative bodies of the government.
_____________________________
Petitioner
SUBSCRIBE AND SWORN to before me this ______th day of
______________, 2007 in the Municipality/City of _____________________,
Philippines, Petitioner exhibiting to me his/her Community Tax Certificate No.
________________ issued at _________________on __________________.
NOTARY PUBLIC
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of ______.
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Republic of the Philippines
Regional Trial Court
________________
Branch _________
_____________________
IN RE : PETITION FOR INVOLUNTARY COMMITMENT TO THE LOCAL
SOCIAL WELFARE AND DEVELOPMENT OFFICE OF MINOR
______________________________ AS AN ABANDONED, NEGLECTED
AND DEPENDENT CHILD.
SP. PROC. NO. ________
______________________________________________________________________
LOCAL SOCIAL WELFARE AND DEVELOPMENT OFFICER MUNICIPALITY /
CITY OF ______________________ PROVINCE OF ____________________________
Petitioner.
x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
---------x
MOTION FOR EXEMPTION OF FILING FEE
Petitioner unto this Honorable Court most respectfully avers, THAT:
1. The above-entitled Petition is filed by the Department of Social Welfare
and Development, a government office;
2. Pursuant to sec. 16 Rule 141 of the Rules of Court the government is
exempted from paying legal fees.
______________________
Petitioner
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Annex B
SOCIAL CASE STUDY REPORT
For CHILDREN IN CONFLICT WITH THE LAW
I. Identifying Information
Name of the Child ______________________________ Alias, if any ____________
Sex __________________ Age __________ Date of Birth ____________________
Place of Birth _____________________ Birth Status ________________________
Highest Educational. Attainment:
___________________________________________________________________
School Last Attended
___________________________________________________________________
Address of School
___________________________________________________________________
Health Condition
___________________________________________________________________
Disability, if any
___________________________________________________________________
Present Address
___________________________________________________________________
Religion
___________________________________________________________________
II. Offense Committed by the Child
Type of Offense
___________________________________________________________________
Date of Apprehension _____________________ Place ______________________
___________________________________________________________________
By Whom ________________________ Address ___________________________
___________________________________________________________________
Name of Victim
___________________________________________________________________
Address of the Victim
___________________________________________________________________
Date of Referral to Social Worker
___________________________________________________________________
Name of Address of Referring Party
___________________________________________________________________
Status Case
___________________________________________________________________
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III. Family Composition
Name Relationship Age Address Employment Income
1.
2.
3.
4.
5.
IV. Problem Presented
Description of the child’s problem/s during intake which includes
physical, social, emotional/psychological condition of the child
Nature/circumstances of apprehension
Causes/factors leading to the offense, frequency/severity of the offense
Action taken by victim against the child
Action taken by concerned authorities e.g Barangay Official
Status of case
V. Background Information
A. The Child
Level of physical, social, mental and emotional development.
Characteristics to include attitude towards authority and
society; ability to communicate his/her thoughts and feelings;
coping ability, problem solving skills, comprehension, critical
thinking and decision making, creativity, degree of self-
awareness
Strengths and weakness
Scholl or work performance
Plans and aspirations
Relationship with parents, siblings, peers, neighbors, teachers,
co-workers, etc.
Violence and abuse experienced
Behavioral before and after commission of the offense
Over-all assessment of the child’s role performance and social
functioning
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B. The Child’s Family
Social-economic condition; access to basic resources (food,
health care, housing, livelihood, employment) and ability to
secure resources, coping ability, experience of oppression and
discrimination, if any)
Decision making structure
Parenting style
Family relationships
Family goals
Communication pattern
Ability to cope with problems
Over-all assessment on parenting capability and support to
every member of the family
C. The Child’s Community
Description of the type of community and neighborhood
Adequacy of housing and other conditions facilitative to child’s
moral development
Availability of social services
Existence of support structures, e.g youth associations
Functionality of Barangay Council for the Protection of Children
VI. Diagnostic Assessment
Statement of the problem
Presence of family and community factors that led to the commission
of crime
The child and his/her family’s resources needed to respond to the
child’s needs
Measures needed to assist the child
VII. Treatment Plan
a. Problem
b. Objective
c. Interventions
d. Activities
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e. Responsible Person (child, parents/guardian/social
worker/community)
f. Time Frame
g. Needed Resources
h. Expected Output
______________________
Social Worker
______________________
Date
Approved by:
______________________________________________________
City/Municipal Social Welfare and Development Officer
_____________________
Date
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Annex C
Victimless crimes with an imposable penalty of not more than six (6)
years of imprisonment
Espionage (Art.117)
Violation of Neutrality (Art.119)
Correspondence with Hostile Country (correspondence has been
prohibited by the Government) (Art.120(1)]
Flight to Enemy’s Country (Art.121)
Interruption of Religious Worship [Art. 132 (1) and (2)]
Offending the Religious Feelings (Art.133)
Conspiracy and Proposal to Commit Rebellion [Art. 136 (2)]
Conspiracy and Proposal to Commit Insurrection [Art.136(3)]
Participating in Sedition [Art. 140 (2)]
Conspiracy to Commit Sedition (Art. 141)
Inciting to Sedition (Art. 142)
Acts Tending to Prevent the Meeting of Congress and Similar Bodies (Art.
143)
Disturbance of Proceedings (Art.144)
Violation of Parliamentary Immunity [Art. 145 (b)]
Attending Illegal Assemblies [Art.146 (b) and (c)]
Organizing Illegal Associations (Art. 147)
Membership in Illegal Associations (Art. 147)
Disobedience to Summons Issued by Congress or Constitutional
Commissions (Art. 150)
Resistance and Disobedience to a Person in Authority or the Agents of
Such Persons (Art. 151)
Making an Outcry Tending to Incite Rebellion or Sedition in a Public
Place, Meeting or Association [Art.153(4)]
Burying with Pomp the Body of a Person Who Has Been Legally Executed
[Art. 153(5)]
Unlawful Use of Means of Publication and Unlawful Utterances (Art.154)
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