Republic of the Philippines

CITY of OLONGAPO
BARANGAY MABAYUAN
Contact No.: (O47-224-5179)
-oOo-

OFFICE OF THE PUNONG BARANGAY

Date Issued: ________________________
BPO No. ______________________

BARANGAY PROTECTION ORDER (BPO)

Name of Respondent/s : _____________________________________
Age : _________
Address : _____________________________________

ORDER
__________________________________, _________ years old, a resident of # ____________________
___________________________ Olongapo City applied for a BPO on___________________________ at
the Office of the Punong Barangay under oath stating that:
“Nais ni
.”

After having heard the application and the witnesses and evidences, the under signed hereby
issues this BPO ordering to immediately cease and desist from causing or threatening to cause physical
harm to ___________________________________________.

This BPO is effective for fifteen (15) days upon its issuance.

VIOLATION OF THIS ORDER IS PUNISHABLE BY LAW

Hon. Edwin M. Esposo

Punong Barangay

Copy received by : _________________________________

Date received : _________________________________

Served by : _________________________________

ATTESTATION
(In case the Punong Barangay is unavailable)

I hereby attest that the Punong Barangay Hon. Edwin M. Esposo, was unavailable, to act on
application for Barangay Protection Order No._______ filed by _______________________ on _______
At _______ am/pm to issue such order.

________________________________
Barangay Kagawad
(Signature over printed name)

NOT VALID WITHOUT OFFICIAL DRY SEAL