REPUBLIC OF THE PHILIPPINES

Barangay Salapan
City of San Juan

OFFICE OF THE LUPONG TAGAPAMAYAPA

_____________________________ Barangay Case No. ___________

_____________________________ For:________________________
Complainant/s

-against-

__________________________
__________________________
Respondent/s

CERTIFICATION TO FILE ACTION

This is to certify that:

1. There has been no personal confrontation between the parties before the Punong Barangay
because the respondent was absent and that mediation failed.

2. The Pangkat Tagapagkasundo was constituted but there has been no personal confrontation
before the Pangkat likewise did not result into a settlement because the respondent was absent.

3. Therefore, the corresponding complaint for the dispute may now be filed in court/government
office.

This ________day of __________________ 2010.

__________________________
Pangkat Secretary

Attested by:

_____________________________ _____________________________
Pangkat Chairperson Pangkat Member

_____________________________
Pangkat Member

Noted by:

PATROCINIO DS. DELA CRUZ

Punong Barangay /
Lupon Chairperson
 REPUBLIC OF THE PHILIPPINES
Barangay Salapan
City of San Juan

OFFICE OF THE LUPONG TAGAPAMAYAPA

_____________________________ Barangay Case No. ___________

_____________________________ For:________________________
Complainant/s

-against-

__________________________
__________________________
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 but
mediation failed;

2. The Pangkat Tagapagkasundo was constituted but the personal confrontation before the Pangkat
likewise did not result into a settlement; and

3. Therefore, the corresponding complaint for the dispute may now be filed in court/government
office.

This ________day of __________________ 2010.

__________________________
Pangkat Secretary

Attested by:

_____________________________ _____________________________
Pangkat Chairperson Pangkat Member

_____________________________
Pangkat Member

Noted by:

PATROCINIO DS. DELA CRUZ

Punong Barangay /
Lupon Chairperson
 REPUBLIC OF THE PHILIPPINES
Barangay Salapan
City of San Juan

OFFICE OF THE LUPONG TAGAPAMAYAPA

_____________________________ Barangay Case No. ___________

_____________________________ For:________________________
Complainant/s

-against-

__________________________
__________________________
Respondent/s

CERTIFICATION TO FILE ACTION

This is to certify that:

1. There has been no personal confrontation between the parties before the Punong Barangay
because the respondent was absent and that mediation failed.

2. The Pangkat Tagapagkasundo was constituted but the personal confrontation before the Pangkat
likewise did not result into a settlement; and

3. Therefore, the corresponding complaint for the dispute may now be filed in court/government
office.

This ________day of __________________ 2010.

__________________________
Pangkat Secretary

Attested by:

_____________________________ _____________________________
Pangkat Chairperson Pangkat Member

_____________________________
Pangkat Member

Noted by:

PATROCINIO DS. DELA CRUZ

Barangay Chairperson /
Lupon Chairperson
 REPUBLIC OF THE PHILIPPINES
Barangay Salapan
City of San Juan

OFFICE OF THE LUPONG TAGAPAMAYAPA

_____________________________ Barangay Case No. ___________

_____________________________ For:________________________
Complainant/s

-against-

__________________________
__________________________
Respondent/s

CERTIFICATION TO FILE ACTION

This is to certify that:

__________________________
Pangkat Secretary

Attested by:

_____________________________ _____________________________
Pangkat Chairperson Pangkat Member

_____________________________
Pangkat Member

Noted by:

PATROCINIO DS. DELA CRUZ

Barangay Chairperson /
Lupon Chairperson