CERTIFICATE TO FILE ACTION

Republic of the Philippines

Province of ______________
Municipality of ______________
Barangay ___________
This is to certify that complainant _____________________ and defendant ___________________
underwent barangay conciliation in this office. There were several meetings held to amicably settle the
issue on _________________________, however, no agreement was reached by the parties except
to elevate the matter to court.
[If the defendant refuses to appear, use this instead:
This is to certify that complainant _____________________ had requested this office to help him/her
amicably settle with defendant ___________________. However, the defendant refused to appear for
at least two scheduled meetings.]
This certificate is issued on ______________________ upon the complainants request as a condition
precedent for the filing of action in court.
(Signature over printed name of Barangay Captain or Presiding Officer of Lupon)