Republika ng Pilipinas

LALAWIGAN NG RIZAL

Road A Phase IV COGEO Village, Barangay Bagong Nayon, Antipolo City 1870 Rizal, Philippines
 barangay_bagongnayon@yahoo.com   647-0942   942-0358   bagongnayon.antipolo@gmail.com
www.facebook.com/BagongNayonOfficialPage   www.antipolo.ph

KP PORMULARYO BLG. 16

BARANGAY CASE NO. _______________

____________________________
COMPLAINANT/S
____________________________
____________________________
(Address)

AGAINST: FOR:

____________________________ ____________________________________
RESPONDENT/S
____________________________ ____________________________________
Barangay Bagong Nayon,Antipolo City
(Address)

AMICABLE SETTLEMENT
We, complainant/s and respondent/s in the above-captioned case, do hereby agree
to settle our dispute as follows:
________________________________________________________
________________________________________________________
________________________________________________________
and bind ourselves to comply honestly and faithfully with the above terms of
settlement.

Entered into this ______ day of __________, 20_______.

Complainant/s Respondent/s
____________________________ ____________________________
____________________________ ____________________________

ATTESTATION

I hereby certify that the foregoing amicable settlement was entered into by the parties
freely and voluntarily, after I had explained to them the nature and consequence of
such settlement.

______________________________
Punong Barangay/Pangkat Chairman

Barangay Bagong Nayon: Kabalikat sa Kaunlaran at Pagbabago ng Lungsod ng Antipolo.