LTIA Enhanced FORMS 1-7

CY 2021 LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 01-PERFORMANCE EVALUATION FORM
A. IDENTIFYING INFORMATION
Lupong Tagapamayapa Barangay ____________________
Municipality Baroy
Region 10
Category 4th-6th Class
B. EVALUATION CRITERIA
CRITERIA ASSIGNED
POINT SCORE
I. EFFICIENCY IN OPERATIONS 35
A. Observance of Settlement Procedure and Settlement 15
Deadlines
B. Systematic Maintenance of Records 5
C. Timely Submission of Reports to Concerned Agencies 5
D. Conduct of monthly meetings exclusively on KP matters 10
II.EFFECTIVENESS IN SECURING THE SETTLEMENT OF 30

INTERPERSONAL DISPUTE OBJECTIVE OF THE KATARUNGANG
PAMBARANGAY (KP) 10
A. Quantity of settled cases against filed 10
B. Quality of Settlement of Cases

10
C. At least 80% compliance with the terms of settlement or
award after the cases have been settled
III. CREATIVITY AND RESOURCEFULNESS OF THE LUPONG 25
TAGAPAMAYAPA
5
A. Settlement Technique
5
B. Coordination with concerned agencies relating to disputes filed
5
C. Sustained information drive to promote KP
10
E. KP Training or seminar within the assessment period
IV. AREA OR FACILITY FOR KP ACTIVITIES 5
V. FINANCIAL OR NON-FINANCIAL SUPPORT 5
TOTAL POINT SCORE 100
1|LTIA FORM 01-PERFORMANCE EVALUATION FORM

CY 2021 LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 01-PERFORMANCE EVALUATION FORM
C. WE CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.
MLGOO JULLIANNE O. SASIL

Chairperson –Municipal Awards Committee
MS. SUSAN S. TION

Vice Chairperson - Municipal Awards Committee
PLT. MARK NOEL L. RONGO

Member - Municipal Awards Committee
HON. VICENTE R. PANGASIAN, JR.

MS. ADELAIDA CANONIGO

D. DATE ACCOMPLISHED
_____________________________________
2|LTIA FORM 01-PERFORMANCE EVALUATION FORM

CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 02-CONSOLIDATED PERFORMANCE EVALUATION FORM
Lupong Tagapamayapa ______________________________
City/Municipality ______________________________
Region ______________________________
Category ______________________________
B. CRITERIA AND PERFORMANCE RATING
CRITERIA ASSIGNE PERFORMANCE TOTAL AVERAG

D POINT RATING POINT E POINT
SCORE EVALUATOR SCORE SCORE
1 2 3 4 5
I. EFFICIENCY IN 35
OPERATIONS
A. Observance of
Settlement
Procedure and
Settlement 15
Deadlines
B. Systematic
Maintenance of
Records
5
C. Timely Submission
of Reports to
Concerned Agencies 5
D. Conduct of monthly
meetings exclusively
on KP matters
10
II.EFFECTIVENESS IN 30
SECURING THE
SETTLEMENT OF
INTERPERSONAL
DISPUTE OBJECTIVE
OF THE
KATARUNGANG
PAMBARANGAY (KP)
10
A. Quantity of settled
cases against filed 10
B. Quality of
Settlement of Cases
10
C. At least 80%
compliance with the
3|LTIA FORM 02-CONSOLIDATED PERFORMANCE EVALUATION

FORM
terms of settlement
or award after the
cases have been
settled
III. CREATIVITY AND 25
RESOURCEFULNESS
OF THE LUPONG
TAGAPAMAYAPA
A. Settlement 5
Technique
B. Coordination with 5
concerned agencies
relating to disputes
filed
C. Sustained 5
information drive to
promote
Katarungang 10
Pambarangay
D. KP Training or
seminar within the
assessment period
IV. AREA OR FACILITY 5

FOR KP ACTIVITIES
V. FINACIAL OR NON- 5
FINANCIAL SUPPORT
GRAND TOTAL POINT

SCORE
100
OVERALL
PERFORMANCE
RATING

FORM
_____________________________
Chairperson - ___________Awards Committee
_____________________________
Vice Chairperson - ___________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
_____________________________
______________________________
_____________________________________

FORM
LTIA FORM 03 [C/M]-COMPARATIVE PERFORMANCE EVALUATION FORM
City/Municipality ______________________________
Province ______________________________
Region ______________________________
Category ______________________________
B. COMPARATIVE EVALUATION RESULTS

LUPONG TAGAPAMAYAPA OVERALL ADJECTIVAL RANK
(LT) PERFORMANCE RATING
RATING
1.
2.
3.
4.
5.
n
_____________________________
_____________________________
_____________________________
______________________________
_____________________________
______________________________
_____________________________________
6|LTIA FORM 03 [C/M]-COMPARATIVE PERFORMANCE

EVALUATION FORM
LTIA FORM 03 [P]-COMPARATIVE PERFORMANCE EVALUATION FORM
Province ______________________________
Region ______________________________
Category ______________________________

RATING
1.
2.
3.
4.
5.
n
_____________________________
_____________________________
_____________________________
______________________________
_____________________________
______________________________
_____________________________________
7|LTIA FORM 03 [P]-COMPARATIVE PERFORMANCE EVALUATION

FORM
LTIA FORM 03 [R]-COMPARATIVE PERFORMANCE EVALUATION FORM
Region ______________________________
Category ______________________________

RATING
1.
2.
3.
4.
5.
n
_____________________________
_____________________________
_____________________________
______________________________
_____________________________
______________________________
_____________________________________
8|LTIA FORM 03 [R]-COMPARATIVE PERFORMANCE EVALUATION

FORM
LTIA FORM 04-PERFORMANCE VALIDATION REPORT FORM
1. VALIDEE LT___________________1. VALIDEE LT______________________
2. FINDINGS_____________________2. FINDINGS________________________
______________________________ _________________________________
3. RECOMMENDATION(S)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. WE CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.
_____________________________
_____________________________
_____________________________
______________________________
_____________________________
______________________________
DATE ACCOMPLISHED
_____________________________________
9|LTIA FORM 04-PERFORMANCE VALIDATION REPORT FORM

LTIA FORM 05-OFFICIAL ENTRY FORM
Date __________________
_______________________
_______________________
The Chairperson
National Awards Committee
Sir/Ma’am:
We are pleased to transmit the list of Regional Finalists for CY Lupong Tagapamayapa
Incentives Awards (LTIA) together with their respective documentation reports, as follows:
Highly Urbanized Cities Category ____________________________________

Component Cities Category ____________________________________
1st-3rd Class Municipalities Category ____________________________________
4th-6th Class Municipalities Category ____________________________________
Please find the following enclosures:

(1) Original copy of LTIA Form 03 [R]-Comparative Performance Evaluation Form duly
accomplished and signed by the Regional Awards Committee;
(2) Certified true copies of LTIA Forms 03 [P] and 03 [C/M]-Comparative Performance
Evaluation Forms duly accomplished and signed by the Provincial/City/Municipal
Awards Committee;
(3) Original copy of LTIA Form 06-Summary of Cases duly accomplished and signed by
the Lupon Secretary, Lupon Chairman, C/MLGOO and LTIA Regional Focal Person;
(4) Original copy of LTIA Form 07-Performance Highlights with required attachments
duly accomplished and signed by the Lupon Secretary, Lupon Chairman, C/MLGOO
and LTIA Regional Focal Person; and
(5) Original copy of LTIA Form 07-A-List of Cases duly accomplished and signed by the
Lupon Secretary and Lupon Chairman.
Very truly yours,
_____________________________
Chairperson, Regional Awards Committee (RAC)
______________________________ ______________________________
Vice Chairperson, RAC Member, RAC
10 | L T I A F O R M 0 5 - O F F I C I A L E N T R Y F O R M
LTIA FORM 05-OFFICIAL ENTRY FORM
______________________________ _____________________________
Member, RAC Member, RAC
______________________________ _____________________________
11 | L T I A F O R M 0 5 - O F F I C I A L E N T R Y F O R M
LTIA FORM 05-A : NON-SUBMISSION OF OFFICIAL ENTRY
_______________________
_______________________
The Chairperson
National Awards Committee
Sir/Ma’am:
We would like to inform you that based on the assessment of the different Awards
Committees, Barangay Lupons under the Category did not qualify in the selection of LTIA
nominees for the national level. Listed below are the following reason/s for the non-
submission of nominees:
REASON/S:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please find the following enclosures:

(1) Original copy of LTIA Form 03 [R]-Comparative Performance Evaluation
Form duly accomplished and signed by the Regional Awards Committee;
(2) Certified true copies of LTIA Forms 03 [P] and 03 [C/M]-Comparative
Performance Evaluation Forms duly accomplished and signed by the
Provincial/City/Municipal Awards Committee;
Very truly yours,
_____________________________
Chairperson, Regional Awards Committee (RAC)
________________________ _________________________
Vice Chairperson, RAC Member, RAC
________________________ _________________________
________________________ _________________________
12 | L T I A F O R M 0 5 - A : N O N - S U B M I S S I O N O F 0 F F I C I A L E N T R Y
LTIA FORM 06-SUMMARY OF CASES
CATEGORY: ____________________________
FINALIST LUPONG TAGAPAMAYAPA : POPULATION :
PUNONG BARANGAY: LAND AREA :
CITY/MUNICIPALITY : TOTAL NO. OF CASES:
MAYOR: NUMBER OF LUPONS:
PROVINCE: MALE :
REGION: FEMALE :
General Instruction: Please read the Technical Notes at the back before accomplishing this form. Supply only the number.
NATURE OF CASES ACTION TAKEN

(1) SETTLED NOT SETTLED
(2) (3) OUTSIDE
BUDGE
CERTIF DROP- THE TOTA
T
CONC ARBIT IED TO PED/ JURISDICTI L
CRI MED PEN- DIS- REPU- ALLO-
CIV OTHE TOT I- - TOT FILE WITH- TOT ON OF THE (cases
MI- IA- DIN MISSE DIATE CATED
IL RS AL LIATI RATI AL ACTION - AL BARANGA filed)
NAL TION G D D (6)
(1b) (1c) (1D) ON ON (2D) IN DRA (3F) Y
(1a) (2a) (3a) (3b) (3c)
(2b) (2c) COURT WN (5)
(3d) (3e)

13 | L T I A F O R M 0 6 - S U M M A R Y O F C A S E S S
***Total Number of Lupons excluding Lupon Chairman and Lupon Secretary

***Please attached Form 06-A “LIST OF CASES”
Guidance on counting: (NOT INCLUDED IN THE SUBMISSION)
Settled Cases arethose cases that undergone KP process such as Mediation, Conciliation and Arbitration without repudiation and
recurrence of cases settled by the Lupon.
Unsettled Cases aredefined as follows:

 Dismissed Cases –cases where complainant and/or respondent after due notice, refuses or willfully fails to appear without
justifiable reason on the date set for mediation, conciliation or arbitration. Such dismissal ordered by the Punong
Barangay/Pangkat Chairman after giving the complainant and/or respondent an opportunity to explain his non-appearance shall
be certified by the Lupon or Pangkat Secretary as the case may be, and shall barthe complainant and/or respondent from seeking
judicial recourse for the same cause of action as that dismissed.
 
 Pending - those cases which have been filed within assessment period but was not able to settle within the assessment period.
   Dropped/Withdrawn - cases where either party shows no intention to continue the process of settling their dispute and
decided to withdraw or dropped the case in the Barangay level. This should be proven by a written document signed by both parties
  stating their lack of intention to continue the case.
 
 
 
 Repudiated is where one of the parties refused to perform the settlement or the arbitration award and file a repudiationto the
Punong Barangaywithin the prescribed period set under the Revised Katarungang Pambarangay Law. Within 10 days from the date
of settlement in case of settlement agreement while within five (5) days from the date of the arbitration award.
Outside the Jurisdiction of the Barangay. These are cases which may be brought to the Barangay level but shall only be recorded in the
Barangay and later on endorsed to the proper office which can give it the appropriate action. This is not included in the total number of
cases filed.
LTIA FORM 07-PERFORMANCE HIGHLIGHTS
Category
Name of the Lupong
Tagapamayapa
Punong Barangay
City/Municipality
Mayor
Province Barangay Logo Here
Region
IRA
Land Area
Population
LTIA Awards Received (all levels)
GENERAL INSTRUCTION: Kindly fill-out this form by following the instructions stated per sub-criteria.
CRITERIA
I. EFFICIENCY IN OPERATIONS
A). Observance of  Describe how the Lupon Secretary records every dispute and attach two (2) photos of the record book and sample entries in
Settlement the record book with caption.
Procedure and
Settlement
NOTE: Record Book entries should contain docket number, names of the parties, date and time filed, nature of the case and
Deadlines
disposition.
1) a) Proper
Recording
of every
16 | L T I A F O R M 0 7 - P E R F O R M A N C E H I G H L I G H T S
dispute
2) Settlement and  Briefly describethe actual experience of the Lupong Tagapamayapa in handling the cases filed in the Barangay.
Award Period (Note: Please do not state the provision of the KP Law re: settlement and award period.)
 Kindly fill-out the table below. First line is filled-out as guide.
 Provide how many case/s is settled through Mediation, Conciliation, Conciliation with Extendible Period, Arbitration and
Conciliation beyond 46 days.
 Attach four (4) photos with caption of on-going settlement of dispute.
SETTLEMENT AND AWARD PERIOD
C46+ -Conciliation beyond 46
LEGEND: M-Mediation C-Conciliation A-Arbitration C w/ EP-Conciliation with Extendible Period
days
CASE CASE TITLE COMPLAINT NATURE DATE DATE OF ACTION DATE OF
NO. TITLE FILED INITIAL TAKEN SETTLE
CONFRONTATION (M, C, C w/ EP, MENT
OF PARTIES A and C46+)
2016-01 Juan Dela Cruz vs. Collection of Sum January January 25, 2016 M January 28,
Juana Change of Money Civil 22, 2016 2016
B. Systematic  Describe the techniques the Lupon Secretary used in keeping a systematic maintenance of records.
Maintenance of  Provide two (2) Photos with caption of each:
Records a) Record Books in reference to the assessment year
b) Computerized records of cases
c) Compilation of the Notices of Meetings, Minutes of Lupon Meetings with Attendance Sheets
d) Compilation of Copies of Reports submitted to the Court and to the DILG
e) Filing cabinet/s
C. Timely Submission  Kindly fill-out the table below and attach transmittal letters of reports submitted to the concerned agencies. First line is
of Reports to filled-out to serve as guide.
Concerned
Agencies TIMELY SUBMISSION OF REPORTS
DATE OF SUBMISSION REPORT/S SUBMITTED AGENCY
April 4, 2016 KP Quarterly Consolidated Reports DILG
Monthly Transmittal of Final Reports MTC
A. Conduct of
Monthly Meetings  Please provide the information needed in the table below and attach the following: (Please see sample in the first line)
a) Copy of Notices of Meetings
Exclusively on
b) Minutes of Lupon Meetings
Katarungang c) Three (3) photos with caption of on-going meeting.
Pambarangay
(KP) Matters SUMMARY OF LUPON MEETINGS
DATE OF NOTICE OF DATE OF THE MEETING AGENDA
MEETING MEETING
February 1, 2016 February 6, 2016  Number of cases on January 2016.
 On-going cases.
II. EFFECTIVENESS IN SECURING THE SETTLEMENT OF

INTERPERSONAL DISPUTE OBJECTIVE OF THE KATARUNGANG PAMBARANGAY
A. Quantity of Settled Please provide brief explanation and the computation based on the definition provided.
cases against filed
Formula: Total Number of Settled Cases X 100
Total number of cases filed
Please attach Form 7-A, List of Cases
B. Quality of
Settlement of Please supply the necessary information and briefly explain how the Lupong Tagapamayapa achieved such quality of settlement of
Cases cases.
Out of the (Total number of Settled Cases), there is only (Percentage of repudiated case/s).
i.e. Out of the 200 settled cases, there is only 2% of repudiated cases.
Out of the (total number of settled cases), there is only (Percentage of non-recurrence) of cases settled by the Lupon.
i.e. Out of the 200 settled cases there is norecurrence of cases settled by the Lupon.
C. At least 80%  Please supply the necessary information and briefly explain how the Lupong Tagapamayapa achieved such quality of
compliance with settlement of cases.
the terms of
settlement or For (validation year), Barangay (name of Barangay), achieved (Percentage) compliance with the terms of settlement or award after
award after the the case have been settled.
case have been i.e. For 2016, Barangay Putingkahoy, achieved 90% compliance with the terms of settlement or award after the case have been
settled settled.
 Kindly fill-out the information needed in the table.

 Attached at least 5 samples of proof of compliance.
MONITORING OF COMPLIANCE TO SETTLEMENT or AWARD

C46+ -Conciliation beyond 46
LEGEND: M-Mediation C-Conciliation A-Arbitration C w/ EP-Conciliation with Extendible Period
days
CASE TITLE ACTION SETTLEMENT OR AWARD STATUS OF
(COMPLAINAN TAKEN MAIN POINT
CASE COMPLAIN COMPLIANC
T (M, C, DATE DATE OF OF REMARKS
NO. T TITLE E
VS. Cw/EP, A AGREED EXECUTION AGREEMENT
(C or NC)
RESPONDENT) and C46+)
2016-01 Juan Dela Cruz Collection of M January 28, February 5, 2016 Respondent C Respondent paid
vs. Juana Sum of 2016 agreed to pay Complainant the
Change Money ComplainantPh amount of PhP
P 500.00 per 500.00 on:
month starting February 5, March
February to pay 6, April 7 and May
for the total 5, 2016.
debt amount of
PhP 2,000.00.
III. CREATIVITY AND RESOURCEFULNESS OF THE LUPONG TAGAPAMAYAPA

A. Settlement
Technique
Describe the settlement technique used by the Lupong Tagapamayapa and explain briefly how each settlement technique helps in
the speedy settlement of disputes and attached two (2) photoswith caption of application of each settlement technique.
B. Coordination with  Please fill out the table provided with the information needed.
Concerned  Explain briefly how the Lupong Tagapamayapa coordinates with concerned agencies relating to disputes filed.
Agencies relating  Attach proofs of coordination such as any form of communication such as letters, emails or any written or verifiable means
to disputes filed of communication, two (2) Photos with caption, Visitor's Log Book dated within the assessment period.
(PNP, DSWD,
DILG, DAR, COORDINATION WITH AGENCIES
DENR, Office of Date of Coordination Agency Coordinated Subject Matter Coordinated Proof of Coordination
the Prosecutor, June 15, 2016 MSWDO Case involving a child (Please attached here proof of
Court/s, DOJ, CHR, Coordination)
volunteer
groups/organization
s, NGOs, CSOs,
Barangay Justice
Advocates)
C. Sustained  Identify and briefly explain each information drive strategies practiced by the Lupong Tagapamayapa to create greater
information drive awareness to the community in promoting Katarungang Pambarangay (KP)
to promote  Attached two (2) photos with caption of the information drive used by the Lupong Tagapamayapa in the promotion of KP
Katarungang in their community.
Pambarangay
Note: Innovative Campaign Strategy Examples: Use of social media such as FB and other innovative strategies like distribution of
flyers, installation of tarpaulins or information board about KP.
D. Katarungang KP TRAINING or SEMINAR
Pambarangay DATE TITLE OF THE TRAINING or SEMINAR VENUE SPONSOR/S PARTICIPANTS
Training or April 14-15, 2016 Training on Gender-Responsive, Child-Friendly and 8th Floor Robredo DILG-RO Lupon Chairman, Lupon
Seminar within the Indigenous Peoples-Relevant Katarungang Pambarangay Hall, Quezon City Secretary and at least 2
Assessment Period Lupong Tagapamayapa
members of all Barangays
in Quezon City
1. Conducted by
the Barangay
2. Training
conducted by
government or Kindly fill-out the information needed in the table below. Provide brief explanation about the training and attached two (2) photos
non- with caption of each training conducted and attended.
government
organizations First line is filled-out as guide.
participated by
Lupon
members
IV. AREA OR FACILITY FOR KATARUNGANG PAMBARANGAY ACTIVITIES

Building structure or  Please describe briefly the building structure or space provided by the Barangay exclusively for KP and Lupong
space Tagapamayapa concerns and attachthree (3) photos with caption.
Note: Area or Facility should have table and chairs to accommodate the parties and the Lupon and record book or computer for
documentation purposes. It should also have a filing cabinet/s where KP documents are maintained.
V. FINANCIAL OR NON-FINANCIAL SUPPORT
1. City, Municipal
or Provincial  Kindly fill-out the information needed in the table below. Explain briefly how the Lupong Tagapamayapa was able to
Government
acquire such grant from those provided in the criteria.
and NGAs
 Please attach proof of granting a support such as Deed of Donation, MOA, Resolution, Appropriation Ordinance of higher
2. People’s Sanggunian, Acknowledgment Receipt, Vouchers, etc.
Organization,
NGOs or FINANCIAL OR NON-FINANCIAL SUPPORT
Private Sector SUPPORT
and others FINANCIAL NON-FINANCIAL DATE GRANTED/GIVEN DONOR/SPONSOR
(Please provide the amount)
PhP 15,000.oo March 25, 2016 Gerry Roxas Foundation,
Inc.
1 Desktop set February 12, 2016 Quezon City Government
Prepared by: Approved by:
Lupon Secretary Lupon Chairman
Signature over
Printed Name
Signature over Printed Name
Verified by:
C/MLGOO RFP
Signature over Printed Name Signature over Printed Name
LTIA FORM 07-A: LIST OF CASES
Name of the Lupong Tagapamayapa
Punong Barangay
City/Municipality
Barangay Logo
Province Here
Region
LIST OF CASES
DATE OF STATUS OF
DATE OF
DATE OF EXECUTION MAIN POINT COMPLIANCE
CASE COMPLAINT DATE INITIAL ACTION
CASE TITLE NATURE SETTLEMENT OF OF ON THE REMARKS
NO. TITLE FILED CONFRON- TAKEN
OR AWARD SETTLEMENT AGREEMENT SETTLEMENT
TATION
OR AWARD OR AWARD
2016- Juan Dele Collection of Civil January January 25, M January 28, February 5, Respondent Complete Respondent paid
01 Cruz vs. Sum of 22, 2016 2016 2016 agreed to pay Complainant the
Juana Money 2016 Complainant amount of PhP
Change PhP 500.00 per 500.00 on:
month starting February 5,
February to pay March 6, April 7
for the total and May 5, 2016.
debt amount of
PhP 2,000.00.

Signature over printed name Signature over printed name
Date: ______________ Date: ______________
LTIA FORM 07-A: LIST OF CASES
Punong Barangay
City/Municipality
Barangay Logo
Province Here
Region
LIST OF CASES
DATE OF STATUS OF
DATE OF
DATE OF EXECUTION MAIN POINT COMPLIANCE
CASE COMPLAINT DATE INITIAL ACTION
CASE TITLE NATURE SETTLEMENT OF OF ON THE REMARKS
NO. TITLE FILED CONFRON- TAKEN
OR AWARD SETTLEMENT AGREEMENT SETTLEMENT
TATION
OR AWARD OR AWARD

Signature over printed name Signature over printed name
Date: ______________ Date: ______________
LTIA FORM 07-B : LUPONG TAGAPAMAYAPA PROFILE

Punong Barangay
City/Municipality
Barangay Logo
Province Here
Region
LUPONG TAGAPAMAYAPA PROFILE
Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member
here here here here here here
Name Name Name Name Name Name

Date of Birth Date of Birth Date of Birth Date of Birth Date of Birth Date of Birth
Terms of Office Terms of Office Terms of Office Terms of Office Terms of Office Terms of Office
Educational Background Educational Background Educational Background Educational Background Educational Background Educational Background
Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member
here here here here here here
Name Name Name Name Name Name

Date of Birth Date of Birth Date of Birth Date of Birth Date of Birth Date of Birth
Terms of Office Terms of Office Terms of Office Terms of Office Terms of Office Terms of Office
Educational Background Educational Background Educational Background Educational Background Educational Background Educational Background
LTIA FORM 07-B : LUPONG TAGAPAMAYAPA PROFILE

Punong Barangay
City/Municipality
Barangay Logo
Province Here
Region
LUPONG TAGAPAMAYAPA PROFILE
Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Chairman here
here here here here
LUPON CHAIRMAN
Name Name Name Name Name
Date of Birth Date of Birth Date of Birth Date of Birth Date of Birth
Terms of Office Terms of Office Terms of Office Terms of Office Terms of Office
Educational Background Educational Background Educational Background Educational Background Educational Background
Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Member Photo of Lupon Secretary here
here here here here
LUPON SECRETARY
Name Name Name Name Name
Date of Birth Date of Birth Date of Birth Date of Birth Date of Birth
Terms of Office Terms of Office Terms of Office Terms of Office Terms of Office
Educational Background Educational Background Educational Background Educational Background Educational Background
Group
Group Photo of the Lupong Tagapamayapa

LTIA Enhanced FORMS 1-7

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CY 2021 LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)

LTIA FORM 01-PERFORMANCE EVALUATION FORM

B. Systematic Maintenance of Records 5

C. Timely Submission of Reports to Concerned Agencies 5

D. Conduct of monthly meetings exclusively on KP matters 10

II.EFFECTIVENESS IN SECURING THE SETTLEMENT OF 30

A. Quantity of settled cases against filed 10

B. Quality of Settlement of Cases

TOTAL POINT SCORE 100

1|LTIA FORM 01-PERFORMANCE EVALUATION FORM

C. WE CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.

MLGOO JULLIANNE O. SASIL

MS. SUSAN S. TION

PLT. MARK NOEL L. RONGO

HON. VICENTE R. PANGASIAN, JR.

MS. ADELAIDA CANONIGO

2|LTIA FORM 01-PERFORMANCE EVALUATION FORM

B. CRITERIA AND PERFORMANCE RATING

CRITERIA ASSIGNE PERFORMANCE TOTAL AVERAG

3|LTIA FORM 02-CONSOLIDATED PERFORMANCE EVALUATION

IV. AREA OR FACILITY 5

GRAND TOTAL POINT

4|LTIA FORM 02-CONSOLIDATED PERFORMANCE EVALUATION

C. WE CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.

Member - ____________Awards Committee

5|LTIA FORM 02-CONSOLIDATED PERFORMANCE EVALUATION

B. COMPARATIVE EVALUATION RESULTS

C. WE CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.

6|LTIA FORM 03 [C/M]-COMPARATIVE PERFORMANCE

B. COMPARATIVE EVALUATION RESULTS

LUPONG TAGAPAMAYAPA OVERALL ADJECTIVAL RANK

C. WE CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.

7|LTIA FORM 03 [P]-COMPARATIVE PERFORMANCE EVALUATION

B. COMPARATIVE EVALUATION RESULTS

LUPONG TAGAPAMAYAPA OVERALL ADJECTIVAL RANK

C. WE CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.

8|LTIA FORM 03 [R]-COMPARATIVE PERFORMANCE EVALUATION

1. VALIDEE LT___________________1. VALIDEE LT______________________

4. WE CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.

9|LTIA FORM 04-PERFORMANCE VALIDATION REPORT FORM

Highly Urbanized Cities Category ____________________________________

Please find the following enclosures:

Very truly yours,

Please find the following enclosures:

Very truly yours,

NATURE OF CASES ACTION TAKEN

***Total Number of Lupons excluding Lupon Chairman and Lupon Secretary

Unsettled Cases aredefined as follows:

II. EFFECTIVENESS IN SECURING THE SETTLEMENT OF

Please attach Form 7-A, List of Cases

 Kindly fill-out the information needed in the table.

MONITORING OF COMPLIANCE TO SETTLEMENT or AWARD

III. CREATIVITY AND RESOURCEFULNESS OF THE LUPONG TAGAPAMAYAPA

IV. AREA OR FACILITY FOR KATARUNGANG PAMBARANGAY ACTIVITIES

V. FINANCIAL OR NON-FINANCIAL SUPPORT

Prepared by: Approved by:

Lupon Secretary Lupon Chairman

Prepared by: Approved by:

Lupon Secretary Lupon Chairman

Prepared by: Approved by:

Lupon Secretary Lupon Chairman

Name of the Lupong Tagapamayapa

LUPONG TAGAPAMAYAPA PROFILE

1. VALIDEE LT_1. VALIDEE LT____