KP Form No.

Republic of the Philippines

Province of Zambales
Municipality of Subic
Barangay Ilwas

OFFICE OF THE LUPONG TAGAPAMAYAPA

TO: ____________________________
________________________________
________________________________
(Complainant/s)

NOTICE OF HEARING
(MEDIATION PROCEEDINGS)

You are hereby required to appeal before me on the ___________ day of

___________________ 20___ at ____________________________________ o’clock in the
_________________________________ for the hearing of your complaint.

This ______________ day of ________________ 20__________.

___________________________________
Punong Barangay

Notified this ________________ day of _________________ 20_____.

Complainant/s

________________________________
________________________________