KP FORM NO.

Republic of the Philippines

Province of ___________________________
City/Municipality of ____________________
Barangay _____________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

__________________________________ Barangay Case No. __________________________

__________________________________ For ___________________________________
Complainant/s, ___________________________________
___________________________________

-against-

___________________________________
___________________________________
Respondent/s.

SUMMONS
TO: _________________________________________________________________________________
_________________________________________________________________________________
Respondents

You are hereby summoned to appear before me in person, together with your witnesses, on the
____Day of _________ 20___ ____o’clock in the morning/afternoon then and there to answer in a
complaint made before me, copy of which is attached hereto. For medication/conciliation of your
dispute with complaint/s.

You are hereby warned that if you refuse or willfully fail to appear in obedience to this
summons. You may be banned from filling any counterclaim arising from said complaint.

FAIL NOT or else face punishment for contempt of court.

This_____ day of_________________________20____.

_______________________________________
Punong Barangay/Lupon Chairman

Katarungan Pambarangay Forms 89