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Ltia Forms 1 7 MS Word
Ltia Forms 1 7 MS Word
A. IDENTIFYING INFORMATION
Lupong Tagapamayapa ______________________________
City/Municipality ______________________________
Region ______________________________
Category ______________________________
B. EVALUATION CRITERIA
A. Settlement Technique 5
_____________________________
Chairperson - ___________Awards Committee
_____________________________
Vice Chairperson - ___________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
D. DATE ACCOMPLISHED
_____________________________________
A. IDENTIFYING INFORMATION
Lupong Tagapamayapa ______________________________
City/Municipality ______________________________
Region ______________________________
Category ______________________________
A. Observance of
Settlement
Procedure and
Settlement 15
Deadlines
B. Systematic
Maintenance of
Records
5
C. Timely Submission
of Reports to
Concerned
5
Agencies
D. Conduct of
monthly meetings
exclusively on KP 10
matters
II. EFFECTIVENESS IN 30
SECURING THE
SETTLEMENT OF
INTERPERSONAL
DISPUTE OBJECTIVE OF
THE KATARUNGANG
PAMBARANGAY (KP)
A. Quantity of settled 10
cases against filed
B. Quality of 10
Settlement of Cases
C. At least 80% 10
compliance with
the 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
V. FINACIAL OR NON- 5
FINANCIAL SUPPORT
PERFORMANCE RATING
_____________________________
Chairperson - ___________Awards Committee
_____________________________
Vice Chairperson - ___________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
D. DATE ACCOMPLISHED
_____________________________________
A. IDENTIFYING INFORMATION
City/Municipality ______________________________
Province ______________________________
Region ______________________________
Category ______________________________
_____________________________
Chairperson - ___________Awards Committee
_____________________________
Vice Chairperson - ___________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
D. DATE ACCOMPLISHED
_____________________________________
A. IDENTIFYING INFORMATION
Province ______________________________
Region ______________________________
Category ______________________________
_____________________________
Chairperson - ___________Awards Committee
_____________________________
Vice Chairperson - ___________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
D. DATE ACCOMPLISHED
_____________________________________
A. IDENTIFYING INFORMATION
Region ______________________________
Category ______________________________
_____________________________
Chairperson - ___________Awards Committee
_____________________________
Vice Chairperson - ___________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
D. DATE ACCOMPLISHED
_____________________________________
10 | L T I A F O R M 0 3 [ R ] - C O M P A R A T I V E P E R F O R M A N C E
EVALUATION FORM
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 04-PERFORMANCE VALIDATION REPORT FORM
2. FINDINGS_____________________ 2. FINDINGS________________________
______________________________ _________________________________
3. RECOMMENDATION(S)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________
Chairperson - ___________Awards Committee
_____________________________
Vice Chairperson - ___________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
_____________________________
Member - ____________Awards Committee
______________________________
Member - ____________Awards Committee
DATE ACCOMPLISHED
_____________________________________
11 | L T I A F O R M 0 4 - P E R F O R M A N C E V A L I D A T I O N R E P O R T F O R M
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
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:
_____________________________
Chairperson, Regional Awards Committee (RAC)
12 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 05-OFFICIAL ENTRY FORM
______________________________ ______________________________
Vice Chairperson, RAC Member, RAC
______________________________ _____________________________
Member, RAC Member, RAC
______________________________ _____________________________
Member, RAC Member, RAC
13 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
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:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________
Chairperson, Regional Awards Committee (RAC)
________________________ _________________________
Vice Chairperson, RAC Member, RAC
________________________ _________________________
Member, RAC Member, RAC
________________________ _________________________
Member, RAC Member, RAC
14 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
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.
15 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 06-SUMMARY OF CASES
Settled Cases are those cases that undergone KP process such as Mediation, Conciliation and Arbitration without repudiation and
recurrence of cases settled by the Lupon.
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 repudiation to the
Punong Barangay within 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.
16 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 06-SUMMARY OF CASES
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.
17 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
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
Settlement entries in 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
dispute
18 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS
2) Settlement and Briefly describe the 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.
19 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS
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
of Reports to is 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
20 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS
A. Conduct of Please provide the information needed in the table below and attach the following: (Please see sample in the first line)
Monthly Meetings 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)
SUMMARY OF LUPON MEETINGS
Matters
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.
B. Quality of
Settlement of Cases Please supply the necessary information and briefly explain how the Lupong Tagapamayapa achieved such quality of
settlement of 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 no recurrence 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
For (validation year), Barangay (name of Barangay), achieved (Percentage) compliance with the terms of settlement or award
settlement or
after the case have been settled.
award after the
case have been i.e. For 2016, Barangay Putingkahoy, achieved 90% compliance with the terms of settlement or award after the case have
settled been settled.
22 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS
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
23 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS
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
Katarungang KP 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
24 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS
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.
25 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS
1. City, Municipal Kindly fill-out the information needed in the table below. Explain briefly how the Lupong Tagapamayapa was able to
or Provincial acquire such grant from those provided in the criteria.
Government
Please attach proof of granting a support such as Deed of Donation, MOA, Resolution, Appropriation Ordinance of
and NGAs
higher Sanggunian, Acknowledgment Receipt, Vouchers, etc.
2. People’s
Organization, FINANCIAL OR NON-FINANCIAL SUPPORT
NGOs or SUPPORT
Private Sector FINANCIAL NON-FINANCIAL DATE GRANTED/GIVEN DONOR/SPONSOR
and others (Please provide the amount)
PhP 15,000.oo March 25, 2016 Gerry Roxas Foundation,
Inc.
1 Desktop set February 12, 2016 Quezon City Government
Verified by:
26 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS
C/MLGOO RFP
Signature over Printed Name Signature over Printed Name
27 | 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
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
CAS DATE OF EXECUTION MAIN POINT COMPLIANCE
COMPLAINT DATE INITIAL ACTION
E CASE TITLE NATURE SETTLEMENT OF OF ON THE REMARKS
TITLE FILED CONFRON- TAKEN
NO. OR AWARD SETTLEMENT AGREEMENT SETTLEMENT
TATION
OR AWARD OR AWARD
2016- Juan Dele Collection Civil January January 25, M January 28, February 5, Respondent Complete Respondent paid
01 Cruz vs. of 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 March 6, April 7
pay for the and May 5, 2016.
total debt
amount of
PhP 2,000.00.
LIST OF CASES
DATE OF STATUS OF
DATE OF
CAS DATE OF EXECUTION MAIN POINT COMPLIANCE
COMPLAINT DATE INITIAL ACTION
E CASE TITLE NATURE SETTLEMENT OF OF ON THE REMARKS
TITLE FILED CONFRON- TAKEN
NO. OR AWARD SETTLEMENT AGREEMENT SETTLEMENT
TATION
OR AWARD OR AWARD
LIST OF CASES
DATE OF STATUS OF
DATE OF
CAS DATE OF EXECUTION MAIN POINT COMPLIANCE
COMPLAINT DATE INITIAL ACTION
E CASE TITLE NATURE SETTLEMENT OF OF ON THE REMARKS
TITLE FILED CONFRON- TAKEN
NO. OR AWARD SETTLEMENT AGREEMENT SETTLEMENT
TATION
OR AWARD OR AWARD
Photo of Lupon Photo of Lupon Photo of Lupon Photo of Lupon Photo of Lupon Photo of Lupon
Member here Member here Member here Member here Member here Member here
Photo of Lupon Photo of Lupon Photo of Lupon Photo of Lupon Photo of Lupon Photo of Lupon
Member here Member here Member here Member here Member here Member here
Photo of Lupon Photo of Lupon Photo of Lupon Photo of Lupon Photo of Lupon Chairman here
Member here Member here Member here Member 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 Photo of Lupon Photo of Lupon Photo of Lupon Photo of Lupon Secretary here
Member here Member here Member here Member 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
CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-B : LUPONG TAGAPAMAYAPA PROFILE