Katarungang Pambarangay Form No.

20
Republic of the Philippines
Province of ________________
City / Municipality of _______
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA
_________________________________
_________________________________
Complainant/s

Barangay Case No. ______________

For:

________________________
________________________
________________________

_________________________________
_________________________________
Respondent/s
CERTIFICATION TO FILE ACTION
This is to certify that:
1.There has been a personal confrontation between the parties before the Punong
Barangay / Pangkat ng Tagapagkasundo.
2. A settlement was reached.
3. The settlement has been repudiated in a statement sworn to before the Punong
Barangay by __________________ on ground of _____________________ .
4. Therefore, the corresponding complaint for the dispute may now be filed in
court / government office.
This __________day of ___________ 20 _______ .
_______________________
Lupong Secretary
ATTESTED:
_____________________
Lupon Chairman