Republic of the Philippines

Province of Zamboanga del Sur

Municipality of Bayog

DIVERSION CONTRACT
For the best interest of _______________________________ and the community,
the following shall be undertaken:

For the child:

1. (Example: Clean the Barangay Park every Sunday from 8 A.M. to 10 A.M. from
January 20___ to June 20___.)
2. __________________________________________________________________
__________________________________________________________________
3. __________________________________________________________________
__________________________________________________________________

For the child’s parents:

1. (Example: Accompany the child during his/her monthly session with the social
worker to the latter’s office every first Monday of the month from January 20__
to June 20__.)
2. __________________________________________________________________
__________________________________________________________________
3. __________________________________________________________________
__________________________________________________________________

Social Worker:

1. (Example: Visit the child in his/her school once a month during the duration of
the diversion program to ascertain whether or not he/she is behaving properly
through interviews with teachers and other students.)
2. __________________________________________________________________
__________________________________________________________________
3. __________________________________________________________________
__________________________________________________________________

This contract has been signed on ______________________

____________________ _______________________ _______________________

Bata Mga Magulang Chair, Diversion Committee

Noted by: _______________________

C/MSWDO
 CERTIFICATION OF FAILURE OF DIVERSION PROCEEDINGS

This is to certify that ________________________________________________ who

committed the offense ________________________________________________

[ ] does not agree to undergo a diversion program

[ ] diversion is not appropriate and applicable to the case at hand due to the
following reasons:

1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________

This certification is issued on __________________________________.

________________________
Chair, Diversion Committee

Noted by: _______________________________

C/MSWDO

PAGPAPATUNAY

Ito ay nagpapatunay na si _____________________________________________ na

nagkasala sa batas ng ______________________________________

[ ] hindi pumapayag na magpasailalim sa isang diversion program

[ ] ang diversion ay hindi angkop o karapat-dapat sa kaso na ito dahil sa
Sumusunod na kadahilanan:

1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________

Ang pagpapatunay na ito ay ibinigay ngayong ________________________.

______________________________
Namumuno ng Diversion Committee

Pinanukalaan ni: ______________________________

C/MSWDO
 ____________________________
City/Municipality

_________________________
Barangay

DIVERSION PROGRAM MONITORING FORM

Date:
A. Basic Information
Name of the CICL
Date of birth: Age: Sex:
School: Grade Level:
Address:
Father: Mother:
Guardian: Relationship to CICL:
B. The Case
Nature of the Offense:
Date of Contract Signing:
Agreed Day of Termination:
Results
Type/Nature of (Include CICL’s Compliance Recommendation
Intervention Activity As well as Hindering and
Facilitating Factors)
1.
2.
3.
4.
5.
6.
7.

________________________
Name and Signature of the Social Worker

CERTIFICATION OF FAILURE OF DIVERSION

 This is to certify that ________________________________________________ who
committed the offense ___________________________________________________ has
failed to comply with the diversion contract to which he/she entered into with the

[ ] Katarungang Pambarangay
[ ] Law Enforcement Officer
[ ] Local Social Welfare and Development Officer
[ ] Prosecutor

due to the following reasons:

1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________

This certification is issued on __________________________________.

__________________________
Social Worker

PAGPAPATUNAY

Ito ay nagpapatunay na si _____________________________________________ na

nagkasala sa batas ng ______________________________________.

[ ] Katarungang Pambarangay
[ ] Law Enforcement Officer
[ ] Local Social Welfare and Development Officer
[ ] Prosecutor

dahil sa sumusunod na kadahilanan:

1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________

Ang pagpapatunay na ito ay ibinigay ngayong ________________________.

______________________________
LSWDO
 DIVERSION PROGRAM TERMINAL REPORT
Date:
A. Basic Information
Name of the CICL
Date of birth: Age: Sex:
School: Grade/Level:
Address:
Father: Mother:
Guardian: Relationship to CICL:
Telephone/Mobile Number:
Offense Committed:
B. The Offended Party:
Name: Age: Sex:
Address:
Telephone/Mobile Number:
C. Summary of the Case/Offense:

D. Type of Diversion Program:

E. Assessment and Final Result of the Diversion Program Implementation (include

observable changes in the changes in the child’s behavior):

F. Further Recommendations:

Prepared by: ________________________

Name and Signature of the Social Worker

LGU/Region _______________________________________ Quarter/Year ______________

I. STATISTICAL REPORT. This statistical report is cumulative, meaning previous cases
will be added to the current reporting period.

A. Types of Crimes Committed by CICL

Age of CICL
# CASES Above Total
TYPES OF CRIMES 15 yrs. 16 yrs. 17 yrs.
M F M F M F M F

B. Diversion Programs for CICL

 Number
by sex Status
Types of Diversion Ongoing Terminated
Program # # Not Remarks
Complied Complied
M F M F M F M F
1. Restitution of property

2. Reparation of damaged
caused
3. Indemnification for
consequential damage
4. Written/Oral Apology

5. Confiscation &
forfeiture of proceeds
and instrument
6. Care, guidance and
supervision orders
7. Counseling

8. Attendance in trainings
& seminars
a. Anger management

b. Problem solving and

conflict resolution
c. Values formation

d. Others

9. Participation in
community-based
programs & services
10. Others

Total

Under column for remarks, indicate the number of cases terminated due to non-compliance
and referred to the next level for another round of diversion proceeding/program.
 C. Support Services Provided to Both the CICL and Victim

Support # of # of Funds Responsible Status

Services Benes. Services Utilized Agency (ongoing/done) Effects

Under the 4th column (Funds Utilized), monetize non-monetary services/activities like
technical assistance, venues, etc., and indicate under the 5 th column (Responsible Agency),
specific agency that provided the service/implement the activity.