Katarungang Pambarangay Form No.

10
Republic of the Philippines
Province of _______________
City / Municipality of _______
Barangay _________________
OFFICE OF THE PUNONG BARANGAY
NOTICE OF CONSTITUTION OF PANGKAT
TO:

_______________________

__________________________

_______________________

__________________________

Complainant/s

Respondent/s

You are hereby required to appear before me on the ________ day of

_____________ 20 _____ , at _____________ oclock in the morning / afternoon for the
constitution of the Pangkat ng Tagapagkasundo which shall conciliate your dispute.
Should you fail to agree to the Pangkat membership or to appear on the aforesaid date for
the constitution of the Pangkat, I shall determine the membership thereof by drawing lots.
This __________ day of ______________ , 20 ___________ .
_____________________
Punong Barangay
Notified this ____________ day of ________ , 20 _____ .
_______________________

______________________

_______________________

______________________

Complainant/s

Respondent/s

Received by Respondent/s Representative/s

________________________

_______________________

________________________

_______________________

(Signature)

(Date)