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Application For Barangay Protection Order: Vawc Form#3 CONTROL NO.

This document is an application for a Barangay Protection Order (BPO) from the Republic of the Philippines. It collects information about the applicant, including their name, address, relationship to the victim, and occupation. It also collects information about the victim, including their name, address, civil status, occupation, and any children. Information is also collected about the respondent, including their name, occupation, address, and civil status. The application asks about the relationship between the complainant and respondent, and what acts are being complained of. It records the date of the offense and where it occurred. The barangay captain verifies the applicant is a resident of the barangay and certifies the information provided.

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Jacjac Famador
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25K views1 page

Application For Barangay Protection Order: Vawc Form#3 CONTROL NO.

This document is an application for a Barangay Protection Order (BPO) from the Republic of the Philippines. It collects information about the applicant, including their name, address, relationship to the victim, and occupation. It also collects information about the victim, including their name, address, civil status, occupation, and any children. Information is also collected about the respondent, including their name, occupation, address, and civil status. The application asks about the relationship between the complainant and respondent, and what acts are being complained of. It records the date of the offense and where it occurred. The barangay captain verifies the applicant is a resident of the barangay and certifies the information provided.

Uploaded by

Jacjac Famador
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

VAWC FORM#3 CONTROL NO.

______

REPUBLIC OF THE PHILIPPINES


NATIONAL CAPITAL REGION
CITY OF MANILA
BARANGAY______ ZONE _____ DISTRICT ____

APPLICATION FOR BARANGAY PROTECTION ORDER

1. NAME OF APPLICANT____________________________________ AGE: _______________


ADDRESS: _____________________________________________ TEL# _______________________
RELATIONSHIP TO VICTIM: _______________________________ OCCUPATION _______________
2. NAME OF VICTIMS: _____________________________________ DATE OF BIRTH: _____________
ADDRESS: _____________________________________________ TEL# _______________________
CIVIL STATUS Single Married Widow Seperated Legally Seperated
3. OCCUPATION/SOURCE OF INCOME: ___________________________________________________
4. NAME/S OF CHILDREN: DATE OF BIRTH: SEX:
_______________________ _____________ ______
_______________________ _____________ ______
_______________________ _____________ ______
_______________________ _____________ ______
4.a Other Children under her care
NAME/S OF CHILDREN: DATE OF BIRTH: SEX:
_______________________ _____________ ______
_______________________ _____________ ______
_______________________ _____________ ______
_______________________ _____________ ______
5. NAME OF RESPONDENT: ________________________________ AGE: ___________
OCCUPATION/SOURCE OF INCOME: ___________________________________________________
ADDRESS: _____________________________________________TEL#: _______________________
CIVIL STATUS Single Married Widow Seperated Legally Seperated
6. Relationship of Compliant to Respondent:
Wife Former Wifre Common Law/Live-in Relationship
Dating Relationship Sexual Relation ship
7. Acts Complained of (Pls. Check)
Treats Physical Injuries
8. Date of commission of the offense: ________________________________
9. Place where the offense was committed: ___________________________
10. If the applicant is not the victim, state the circumstances of refusal to give consent of the victim/

___________________________________
Signature of Appicant Over Printed Name
____________________
Date

VERIFICATION OF PUNONG BARANGAY

I certify that the applicant for BPO who personally appeared before me is a bonafinde resident of
this barangay and is the same person who supplied all the above information and attest to the correctness
of said information

__________________________
PUNONG BARANGAY

Date Issued: ___________________

VAWC FORM#3 CONTROL NO.______ REPUBLIC OF THE PHILIPPINES NATIONAL CAPITAL REGION CITY OF MANILA BARANGAY______ ZONE _____ D

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