CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)

LTIA FORM 01 - PERFORMANCE EVALUATION FORM

A. IDENTIFYING INFORMATION
Lupong Tagapamayapa
City/Municipality
Region
Category

B. EVALUATION CRITERIA

ASSIGNED POINT
CRITERIA
SCORE
I. EFFICIENCY IN OPERATIONS 35
A. Observance of Settlement Procedure and Settlement Deadlines 15 15

B. Systematic Maintenance of Records 5 5

C. Timely Submission of Reports to Concerned Agencies 5 5

D. Conduct of monthly meetings exclusively on KP matters 10 10 35

II. EFFECTIVENESS IN SECURING THE SETTLEMENT OF

INTERPERSONAL DISPUTE OBJECTIVE OF THE 30
KATARUNGANG PAMBARANGAY (KP)

A. Quantity of settled cases against filled 10 5

B. Quality of Settlement of Cases 10 5

C. At least 80% compliance with the terms of settlement or award 10 5

after the cases have been settled 15

III. CREATIVITY AND RESOURCEFULNESS OF THE LUPONG

25
TAGAPAMAYAPA
A. Settlement Technique 5 5

B. Coordination with concerned agencies relating to disputes filed 5 5

C. Sustained information drive to promote KP 5 5

D. KP Training or seminar within the assessment period 10 0 15

IV . AREA OR FACILITY FOR KP ACTIVITIES 5 5

V. FINANCIAL OR NON-FINANCIAL SUPPORT 0 5

TOTAL POINT SCORE 70 100

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 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 01 - PERFORMANCE EVALUATION FORM

C. WE CERTIFY THE CORRECTNESS OF THE ABOVE INFORMATION

Chairperson - Awards Committee

Vice Chairperson - Awards Committee

Member - Awards Committee

Member - Awards Committee

Member - Awards Committee

Member - Awards Committee

D. DATE ACCOMPLISHED

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 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 02 - CONSOLIDATED PERFORMANCE EVALUATION FORM

A. IDENTIFYING INFORMATION
Lupong Tagapamayapa BARANGAY FVR
City/Municipality NORZAGARAY
Region 3
Category

B. CRITERIA AND PERFORMANCE RATING

PERFORMANCE
ASSIGNED RATING TOTAL AVERAGE
CRITERIA POINT POINT POINT
SYSTEM EVALUATOR SCORE SCORE
1 2 3 4 5
I. EFFICIENCY IN OPERATIONS
35
A. Observance of Settlement
Procedure and Settlement
Deadlines 15

B. Systematic Maintenance of
Records 5

C. Time Submission of Reports

to Concerned Agencies
5

D. Conduct of monthly
meetings exclusively on KP
matters 10

II. EFFECTIVENESS IN SECURING

THE SETTLEMENT OF
INTERPERSONAL DISPUTE
OBJECTIVE OF THE
KATARUNGANG PAMBARANGAY 30
(KP)

A. Quantity of settled cases 10

againts filed

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 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 02 - CONSOLIDATED PERFORMANCE EVALUATION FORM

PERFORMANCE
ASSIGNED RATING TOTAL AVERAGE
CRITERIA POINT POINT POINT
SYSTEM EVALUATOR SCORE SCORE
1 2 3 4 5
B. Quality of Settlement of 10
Cases

C. At least 80% compliance 10

with the terms of settlement
or award after the cases have
been settled

III. CREATIVITY AND

RESOURCEFULNESS OF THE
LUPONG TAGAPAMAYAPA 25

A. Settlement Technique 5

B. Coordination with concerned 5

agencies relating to disputes
filed

C. Sustained information drive 5

to promote Katarungang
Pambarangay

D. KP Training or seminar 10
within the assessment period

IV. AREA OR FACILITY FOR KP

ACTIVITIES 5

V. FINANCIAL OR NON-
FINANCIAL SUPPORT 5

GRAND TOTAL POINT SCORE 100

OVERALL PERFORMANCE
RATING

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 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 03 - CONSOLIDATED PERFORMANCE EVALUATION FORM

C. WE CERTIFY THE CORRECTNESS OF THE ABOVE INFORMATION

Chairperson - Awards Committee

Vice Chairperson - Awards Committee

Member - Awards Committee

Member - Awards Committee

Member - Awards Committee

Member - Awards Committee

D. DATE ACCOMPLISHED

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 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 03 [P] - COMPARATIVE PERFORMANCE EVALUATION FORM

A. IDENTIFYING INFORMATION
Province BULACAN
Region 3
Category

B. COMPARATIVE EVALUATION RESULTS

OVERALL
ADJECTIVAL
LUPONG TAGAPAMAYAPA (LT) PERFORMANCE RANK
RATING
RATING

C. WE CERTIFY THE CORRECTNESS OF THE ABOVE INFORMATION

Chairperson - Awards Committee

Vice Chairperson - Awards Committee

Member - Awards Committee

Member - Awards Committee

Member - Awards Committee

Member - Awards Committee

D. DATE ACCOMPLISHED

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 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
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

Chairperson - Awards Committee

Vice Chairperson - Awards Committee

Member - Awards Committee

Member - Awards Committee

Member - Awards Committee

Member - Awards Committee

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 D. DATE ACCOMPLISHED

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 06: SUMMARY OF CASES

CATEGORY: _______________________

FINALIST LUPONG TAGAPAMAYAPA BARANGAY FVR POPULATION: 13,542

PUNONG BARANGAY HON. CARLITO DC. TEBOSO LAND AREA: 53 HECTARES
CITY/MUNICIPALITY NORZAGARAY TOTAL NO. OF CASES: 36
MAYOR: HON. ALFREDO "FRED" GERMAR NUMBER OF LUPONS: 11
PROVINCE: BULACAN MALE: 1
REGION: 3 FEMALE: 10

General Instruction: Please read the technical Notes at the back before accomplishing this form. Supply only the number.
ACTION TAKEN
NATURE OF CASES (1)
SETTLED (2) NOT SETTLED OUTSIDE THE BUDGET
TOTAL
PEN- CERTIFIED JURISDICTION ALLO-
(cases
CRIM MEDIA- CONCI- ARBIT- DING DIS REPU- TO FILE DROPPED OF THE CATED
CML OTHERS TOTAL TOTAL TOTAL BARANGAY (5) filed)
-NAL TION LIATION RATION (3a) MISSED DIATED ACTION IN WITH (6)
(1b) (1c) (1D) (2D) DRAWIN (3E) (3f)
(1a) (2a) (2b) (2c) (3b) (3c) COURT (3d)

1st Quarter 11 3 2 0 5 1 1 0 4 6 1 11 0

2nd Quarter 7 1 1 0 2 2 0 0 3 0 5 0 7 0

3rd Quarter 11 2 2 0 4 0 0 0 6 1 7 0 11 0

4th Quarter 7 1 1 0 2 3 0 0 2 0 5 0 7 0

*** Total Number of Lupons excluding Lupon Chairman and Lupon Secretary
*** Please attached Form 06-A "List OF CASES"

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 06: SUMMARY OF CASES

Guidance on counting: (NOT INCLUDED IN THE SUBMISSION)

Settled Cases are those cases that undergone KP process such as Mediation, Conciliation and Arbitration without repudiation
by the Lupon.

Unsettled Cases are defined as follows:

Dismissed Cases - cases where complainant and/or respondent after due notice, refuses or willfully fails
Ø
reason on the date set for mediation, conciliation or arbitration. Such dismissal ordered by the Punong Ba
after giving the complainant and/or respondent an opportunity to explain his non-appearance shall be certifie
Secretary as the case may be, and shall bar the complainant and/or respondent from seeking judicial recourse
as that dismissed.

Ø Pending - those cases which have been filed within assessment period but was not able to settle within the a

Ø Dropped/Withdrawn - cases where either party shows no intention to continue the process of settling th
withdraw or dropped the case in the Barangay level. This should be proven by a written document signed by
of intention to continue the case.

Ø Repudiated is where one of the parties refused to perform the settlement or the arbitration award and file a r
Barangay within the prescribed period set under the Revised Katarungang Pambarangay Law. Within 10 day
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 rec
later on endorsed to the proper office which can give it the appropriate action. This is not included in the total number of case

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TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
FORM 06: SUMMARY OF CASES

Mediation, Conciliation and Arbitration without repudiation and recurrence of cases settled

nd/or respondent after due notice, refuses or willfully fails to appear without justifiable
n or arbitration. Such dismissal ordered by the Punong Barangay/Pangkat Chairman
an opportunity to explain his non-appearance shall be certified by the Lupon or Pangkat
omplainant and/or respondent from seeking judicial recourse for the same cause of action

ithin assessment period but was not able to settle within the assessment period.

ty shows no intention to continue the process of settling their dispute and decided to
evel. This should be proven by a written document signed by both parties stating their lack

to perform the settlement or the arbitration award and file a repudiation to the Punong
the Revised Katarungang Pambarangay Law. Within 10 days from the date of settlement
e(5) days from the date of the arbitration award.

h may be brought to the Barangay level but shall only be recorded in the Barangay and
priate action. This is not included in the total number of cases filed.

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

Category
Name of the Lupong Tagapamayapa
Punong Barangay
City/Municipality
Mayor
Province
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
Settlement
Procedure and
Settlement
Deadlines

1) a. Proper
Recording of
every dispute

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NTIVES AWARD (LTIA)
HIGHLIGHTS

Barangay Logo Here

per sub-criteria.

A
ATIONS
Ÿ

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

Category
Name of the Lupong Tagapamayapa BARANGAY FVR
Punong Barangay HON. CARLITO DC. TEBOSO
City/Municipality NORZAGARAY
Mayor HON. ALFREDO "FRED" GERMAR
Province BULACAN Barangay Logo Here
Region 3
IRA NO IRA
Land Area 53 HECTARES
Population 13,542
LTIA Awards Received (all levels) NONE
GENERAL INSTRUCTION: Kindly fill-out this form by following the instructions stated per sub-criteria.

CRITERIA
I. EFFICIENCY IN OPERATIONS
A. Observance of
Settlement
Procedure and
Settlement Ÿ Please explain briefly how the Lupon Secretary records every dispute and attach two (2) photos of the record book and sample entries
Deadlines in the record book with caption.

1) a. Proper NOTE: Record Book entries should contain docket number, names of the parties, date and time filed, nature of the case and disposition.
Recording of
every dispute

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 Ÿ

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

2) Settlement and SETTLEMENT AND AWARD PERIOD

Award Period LEGEND: M-Mediation C-Conciliation A-Arbitration C w/ EP-Conciliation with C46+ -Conciliation beyond 46 days
Extendible Period

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

2) Settlement and Ÿ ŸBriefly describe the actual experience of the Lupong Tagapamayapa in handling the cases filed in the Barangay. (Note: Please do not state
Award Period the provision of the KP Law re: settlement and award period.)
Ÿ ŸKindly fill-out the table below. First line is filled-out as guide.
Ÿ ŸProvide how many case/s is settled through Mediation, Conciliation, Conciliation with Extendible Period, Arbitration and Conciliation
beyond 46 days.
Ÿ ŸAttach four (4) photos with caption of on-going settlement of dispute.
SETTLEMENT AND AWARD PERIOD
LEGEND: M-Mediation C-Conciliation A-Arbitration C w/ EP-Conciliation with Extendible C46+ -Conciliation beyond 46 days
Period
DATE OF INITIAL ACTION TAKEN
DATE DATE OF
Case No. CASE TITLE COMPLAINT TITLE NATURE CONFRONTATION (M, C, C w/ EP, A
FILED OF PARTIES and C46+)
SETTLEMENT

2021-13/Jan John Anthony B. Nardo Vs. Jr Collection of Sum Money Civil 10-Jan-21 13-Jan-21 M 1/13/2021
Mayor
Celestino De Dios Vs. Alicia
2021-14/Jan Collection of Sum Money Civil 11-Jan-21 14-Jan-21 M 14-Jan-21
Escober

Bernardita Maitim Vs. Khalelite

2021-08/Feb Slight Physical Injury Civil 5-Feb-21 8-Feb-21 C 15-Feb-21
Lucero

Yolanda Acebo Vs. Laylanie

2021-22/Feb House Problem Civil 19-Feb-21 22-Feb-21 C 22-Feb-21
Delos Santos

2021-05/Mar Efren Rubio Vs. Jose Bon Collection of Sum Money Civil 2-Mar-21 5-Mar-21 M 28-Mar-21

Warren B. Masinda Vs. Marry

2021-14/Apr Collection of Sum Money Civil 11-Apr-21 14-Apr-21 M 30-Apr-21
Rose Limihan

2021-18/Jun Deo Belleza Vs. Aljer Magno Threat Civil 15-Jun-21 18-Jun-21 C 25-Jun-21

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 2021-13/Jul John Benedick J. Adao Vs. Threat Civil 10-Jul-21 13-Jul-21 M 22-Jul-21
Rolando Rellora
Mark Joseph F. Signo Vs.
2021-11/Aug Libel Civil 9-Aug-21 11-Aug-21 C 19-Aug-21
Victorino Pasibe

2021-16/Sept. Joan Alonzo Vs. Jinelyn Lora Libel Civil 13-Sep-21 16-Sep-21 C 23-Sep-21

2021-24/Sept. Nena Castillo Vs. Carlo Aguilar House Problem Civil 21-Sep-21 24-Sep-21 M 24-Sep-21

Joan Serna Vs. Mark Anthony

2021-07/Oct Gate Damage Civil 4-Oct-21 7-Oct-21 C 7-Oct-21
Rocero

Crisanta Cabrero Vs. Jenny

2021-19/Oct Electric/Water Bills Civil 16-Oct-21 19-Oct-21 M 19-Oct-21
Sobrevega

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

B. Systematic
Maintenance of
Records

TIMELY SUBMISSION REPORTS

DATE OF SUBMISSION REPORT/S SUBMITTED AGENCY
C. Timely Submission Dec. 6, 2021 KP Yearly Consolidated Reports Monthly Transmittal of Final Report DILG
of Reports to the
Concerned Agencies

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

B. Systematic Ÿ Describe the techniques the Lupon Secretary used in keeping a systematic maintenance of records.
Maintenance of Ÿ Provide two (2) Photos with caption of each:
Records
a) Record Books in reference to the assesssment year
b) Computerized records of cases
c) Compilation of the Notices of Meeting, Minutes of Lupon Meetings with Attendance Shhets
d) Compilation of Copies of Reports submitted to the Court and to the DILG
e) Filing cabinet/s

Ÿ Kindly fill-out the table below and attach transmittal letters of reports submitted to the concerned agencies. First line is filled-out to
serve as guide
C. Timely Submission TIMELY SUBMISSION REPORTS
of Reports to the DATE OF SUBMISSION REPORT/S SUBMITTED AGENCY
Concerned Agencies DILG
4-Apr-16 KP Quarterly Consolidated Reports Monthly Transmittal of Final Report
MTC

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

A. Conduct of Monthly SUMMARY OF LUPON MEETINGS

Meetings Exclusively on
Katarungang DATE OF NOTICE OF DATE OF THE MEETING AGENDA
Pambarangay (KP) MEETING MEETING
Matters Number of case on year 2020
Dec. 28, 2020 Jan. 4, 2021 On going case
Number of case on January 2021
Feb. 3, 2021
Jan. 27, 2021 On going case
Number of case on February 2021
Feb. 24, 2021 March 2, 2021
On going case
Number of case on May 2021
May 30, 2021 June 7, 2021
On going case
Number of case on June 2021
June 27, 2021 July 5, 2021
On going case

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

A. Conduct of Monthly
Meetings Exclusively on Ÿ Please provide the information needed in the table below and attach the following: (Please see sample in the first line)
Katarungang
a) Copy of Notices of Meetings
Pambarangay (KP)
Matters b) Minutes of Lupon Meetings
c) Three (3) photos with caption of on-going meeting.
SUMMARY OF LUPON MEETINGS
DATE OF NOTICE OF DATE OF THE MEETING AGENDA
MEETING MEETING

1-Feb-16 6-Feb-16 Ÿ Number of cases on January 2016.

Ÿ On-going cases.

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

II. EFFECTIVENESS IN SECURING THE SETTLEMENT OF INTERPERSONAL DISPUTE OBJECTIVE OF THE KATARUNGANG
PAMBARANGAY
A. Quantity of Settled
cases against filed

Formula: Total Number of Settled Cases 13

x 100
Total number of cases filed 13

B. Quality of Settlement of
Cases

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

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
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 settle by the Lupon.
i.e. Out of the 200 settled cases, there is no recurrence of cases settled by the Lupon.

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

C. At least 80% MONITORING OF COMPLIANCE TO SETTLEMENT or AWARD

compliance with the LEGEND: M-Mediation C-Conciliation A-Arbitration C w/ EP-Conciliation with Extendible Period C46+ -Conciliation beyond 46 days
terms of settlement
or award after the ACTION SETTLEMENT OR AWARD
CASE TITLE
case have been TAKEN (M, MAIN POINT OF STATUS OF
CASE NO. (COMPLAINANT VS. COMPLAINT TITLE COMPLIANC REMARKS
settled RESPONDENT)
C, Cw/EP, A DATE DATE OF AGREEMENT E (C or NC)
and C46+) AGREED EXECUTION

2021-13/Jan John Anthony B. Nardo Vs. Jr Collection of Sum Money 13-Jan-21 13-Jan-21 Respondent agree to Respondent immediate pay ₱
pay ₱ 1000.00 pesos to 1000.00 to the complainant
Mayor
complainant 1
2021-14/Jan Celestino De Dios Vs. Alicia Collection of Sum Money 14-Jan-21 14-Jan-22 Respondent agree to Respondent agreed to pay ₱
pay ₱ 250.00 pesos to 250.00 to the complainant
Escober complainant every every Sunday until she pays
Sunday to pay ₱ ₱ 13,000.00 pesos and she
13,000.00 will add when she has extra
money.

2
2021-08/Feb Bernardita Maitim Vs. Slight Physical Injury 8-Feb-21 9-Feb-21 Respondent agreed to The two respondents pay for
pay half the CT-Scan the bills in CT-Scan
Khalelite Lucero fee and the mother of
other respondent and
the mother of another
respondent will also pay
half

3
2021-22/Feb Yolanda Acebo Vs. Laylanie House Problem 22-Feb-21 22-Mar-21 Respondent agreed to Respondent agreed to pay
pay the amount of ₱ the amount of ₱ 30,000.00.
Delos Santos 30,000.00 March 22, 2021

4
2021-05/Mar Efren Rubio Vs. Jose Bon Collection of Sum Money 5-Mar-21 15-Mar-21 Respondent agreed to Respondent agreed to pay
pay the amount of ₱ the amount of ₱ 5,000.00
5,000.00

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 2021-11/Mar Ana Cinco Vs. Julie Buendia Theft

2021-14/Apr Warren B. Masinda Vs. Collection of Sum Money 03-Apr.21 03-Sept.21 Respondent agreed to Respondent agreed to pay
pay the ampunt of ₱ the ampunt of ₱ 500.00
Marry Rose Limihan 500.00 Every 3rd and 18th of the
Month
6
2021-18/Jun Deo Belleza Vs. Aljer Magno Threat 25-Jun.21 25-Jun.21 both side reconciled and both side reconciled and
forgave forgave. The complainant
asked not to repart the
incident.

7
2021-13/Jul John Benedick J. Adao Vs. Threat 22-Jul.21 22-Jul.21 Respontent apologized Respontent apologized and
the complianant forgave and
Rolando Rellora asked not to repeat the
incident
8
2021-14/Jul Vivian Molina V.s Aileen Unjustvexation
Francisco
2021-11/Aug Mark Joseph F. Signo Vs. Libel Respontent apologized Respontent apologized and
the complianant forgave and
Victorino Pasibe asked not to repeat the
incident
9
2021-16/Sept. Joan Alonzo Vs. Jinelyn Lora Libel 23-Sep.21 24-Sep.21 respondent agreed to the respondent agreed to
complainant asked for complainant's request for
Public Apology Public apology in the area
where complainant was
humiliated 10
2021-24/Sept. Nena Castillo Vs. Carlo House Problem 24-Sept. 21 29-Nov.21 respondent agreed to respondent agreed to return
return only the only the ₱100,000.00 paid in
Aguilar ₱100,000.00 paid in fees. Nov. 29, 2021
fees
11
2021-07/Oct Joan Serna Vs. Mark Anthony Gate Damage/Physical Attack 07-Oct.21 07-Oct.21 respondent agreed with respondent agreed with the
the complianant to complianant to simply repair
Rocero repair the broken gate the broken gate and not to
and not to repeat the repeat the physical attact to
physical attack on the the complianant. The gate
complianant was repaired after
negotiation

12

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 2021-19/Oct Crisanta Cabrero Vs. Jenny Renting House, Electric and 19-Oct.21 19-Nov.21 respondent agreed with
Water Bills the complianant to pay
Sobrevega the electric bills and
water bills and was
given a month's grace
before leaving home
respondent agreed with the
complianant to pay the
electric bills and water bills
and was given a month's
grace before leaving home
on Nov. 19, 2021

13

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07: PERFORMANCE HIGHLIGHTS

C. At least 80% Ÿ Please supply the necessary information and briefly explain how the Lupong Tagapamayapa achieved such quality of
compliance with the settlement of cases.
terms of settlement
or award after the
case have been For (validation year), Barangay (name of Barangay), achieved (Percentage), compliance with the terms of settlement or
settled award after the case have been settled.

i.e. For 2016, Barangay Putingkahoy, achieved 90% compliance with the terms of settlement or award after the case have
been settled.

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

Ÿ Attached at least 5 samples of proof of compliance.

MONITORING OF COMPLIANCE TO SETTLEMENT or AWARD

LEGEND: M-Mediation C-Conciliation A-Arbitration C w/ EP-Conciliation with Extendible Period C46+ -Conciliation beyond
46 days
CASE TITLE ACTION SETTLEMENT OR AWARD
MAIN POINT STATUS OF
(COMPLAINANT COMPLAINT TAKEN (M,
CASE NO. DATE DATE OF OF COMPLIANC REMARKS
VS. TITLE C, Cw/EP, A E (C or NC)
AGREED EXECUTION AGREEMENT
RESPONDENT) and C46+)

2016-01 Juan Dela Cruz M 28-Jan-16 5-Feb-16 Respondent C

vs. Juana Change Collection of agreed to pay
Sum of Complainant
Money Php 500.00 per Respondent
paid
month starting
Complainan
February to pay t the amount
for the total of Php
debt amount of 500.00 on:
Php 2,000.00. Feb 5,
March 6,
April 7 and
May 5,
2016.

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III. CREATIVITY AND RESOURCEFULNESS OF THE LUPONG TAGAPAMAYAPA

A. Settlement Techniques

B. Coordination with COORDINATION WITH AGENCIES

Concerned Agencies Date of Coordination Agency Coordinated Subject Matter Coordinated Proof of Coordination
relating to dispute filed
(PNP, DWSD, DILG,
DAR, DENR Office of the
Prosecutor, Court/s, DOJ,
CHR, volunteer
groups/organizations,
NGOs, CSOs, Barangay
Justice Advocates)

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III. CREATIVITY AND RESOURCEFULNESS OF THE LUPONG TAGAPAMAYAPA

A. Settlement Techniques

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) photos with caption of application of each settlement technique

B. Coordination with
Concerned Agencies
relating to dispute filed
(PNP, DWSD, DILG,
DAR, DENR Office of the
Prosecutor, Court/s, DOJ,
CHR, volunteer
groups/organizations,
NGOs, CSOs, Barangay
Justice Advocates)
ŸPlease fill out the table provided with the information needed.
ŸExplain briefly how the Lupong Tagapamayapa coordinates with concerned agencies relating to disputes filed
ŸAttach proofs of coordination such any form of communication such as letter, emails or any written or verifiable means of
communication, two (2) Photos with caption, Visitor's Log Book dated within the assessment period.
COORDINATION WITH AGENCIES
Date of Coordination Agency Coordinated Subject Matter Coordinated Proof of Coordination
15-Jun-16 MSWDO Case involving a child
(Please attached
here proof of
Coordination)

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C. Sustained
information drive to
promote Katarungan
Pambarangay

D. Katarungan
Pambarangay KP TRAINING or SEMINAR
Training or Seminar
DATE TITLE OF THE SEMINAR VENUE SPONSOR/S PARTICIPANTS
within the
Assessment Period

1.) Conducted by
the Barangay

2.) Training
conducted by
government or non-
government
organizations
participated by
Lupon members

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C. Sustained ŸIdentify and briefly explain each information drive strategies practiced by the Lupong Tagapamayapa to create greater awareness to
information drive to the community in promoting Katarungan Pambarangay (KP)
promote Katarungan
Pambarangay ŸAttached two (2) photos with caption of the information drived used by the Lupong Tagapamayapa in the promotion of KP in their
comminity.

Note: Innovative Campaign Strategy Examples: Use of social media such as FB and other innovative strategies like distribution of
flyers, installation of tarpulins or information board about KP.
D. Katarungan
Pambarangay Kindly fill-out the information needed in the table below. Provide brief explanation about the training and attached two (2) photos with
Training or Seminar caption of each training conducted and attended
within the
Assessment Period
First line is filled-out as guide.
1.) Conducted by
the Barangay KP TRAINING or SEMINAR

2.) Training April 14-15, 2016 Training of Gender-Responsive, Child- 8 Fllor Robredo
th
DILG-RO
conducted by Friendly and Indigenous Peoples- Hall, Quezon City
government or non- Relevant Katarungang Pambarangay
government
organizations Lupon Chairman, Lupon
participated by Secretary and atleast 2 Lupong
Lupon members Tagapamayapa member of all
Barangay in Quezon City

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IV. AREA OR FACILITY FOR KATARUNGANG PAMBARANGAY ACTIVITIES

Building structure
or space

V. FINANCIAL OR NON-FINANCIAL SUPPORT

SUPPORT
1. City, Municipal
FINANCIAL DATE GRANTED/GIVEN DONOR/SPONSOR
or Provincial NON-FINANCIAL
Government and (Please provide the amount)
NGAs

2. People's
Organization,
NGOs or Private
Sector and others

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IV. AREA OR FACILITY FOR KATARUNGANG PAMBARANGAY ACTIVITIES

Building structure ŸPlease describe briefly the building structure or space provided by the Barangay exclusively for KP and Lupong
or space Tagapamayapa concerns and attach three (3) photos with captions.

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

ŸKindly fill-out the information needed in the table below. Explain briefly how the Lupong Tagapamayapa was able to acquire
1. City, Municipal such grant from those provided in the criteria
or Provincial
Government and ŸPlease attach proof of granting a support such as Deed of Donation, MOA, Resolution, Appropriation Ordinance of higher
NGAs Sanggunian, Acknowledgement Reciept, Voucher, etc.

2. People's
FINANCIAL OR NON-FINANCIAL SUPPORT
Organization,
NGOs or Private SUPPORT
Sector and others FINANCIAL DATE GRANTED/GIVEN DONOR/SPONSOR
NON-FINANCIAL
(Please provide the amount)
PhP 15,000.00 March 25,2016 Gerry Roxas Foundation, Inc.
1 Desktop set Febuary 12, 2016 Quezon City Government

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Prepared by: Approved by:

REYNALD ALEJO UMBAÑA HON.CARLITO DC. TEBOSO

Signature over Printed Name Signature over Printed Name

Verify by:

C/MLGOO RFP
Signature over Printed Name Signature over Printed Name

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LTIA FORM 07-A: LIST OF CASES

Name of the Lupong Tagapamayapa

Punong Barangay
Barangay
City/Municipality
Logo Here
Province
Region
LIST OF CASES

DATE OF DATE OF MAIN POINT STATUS OF

DATE OF EXECUTION COMPLIANCE
CASE CASE COMPLIANT DATE INITIAL ACTION OF
NATURE SETTLEMENT OF ON THE REMARKS
NO. TITLE TITLE FILED CONFRON- TAKEN OR AWARD SETTLEMENT
AGREEMEN SETTLEMENT
TATION OR AWARD T OR AWARD

Prepared by: Approved by:

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 Lupon Secretary Lupon Chairman
Signature over printed name Signature over printed name
Date : Date :

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07-A: LIST OF CASES

Name of the Lupong Tagapamayapa

Punong Barangay
Barangay
City/Municipality
Logo Here
Province
Region
LIST OF CASES

DATE OF DATE OF MAIN POINT STATUS OF

DATE OF EXECUTION COMPLIANCE
CASE CASE COMPLIANT DATE INITIAL ACTION OF
NATURE SETTLEMENT OF ON THE REMARKS
NO. TITLE TITLE FILED CONFRON- TAKEN OR AWARD SETTLEMENT
AGREEMEN SETTLEMENT
TATION OR AWARD T OR AWARD

2016-01 Juan Dela Collection of Sum of Civil 22-Jan-16 26-Jan-16 M 28-Jan-16 5-Feb-16 Complete Respondent paid
Cruz vs Money Complainant the
Juana amount of PhP
Change Respondent 500.00 on
agreed to pay February 5,
Complainant PhP March 6, and May
500,000 per 5, 2016
month starting
February to pay
for the total debt
amount of PhP
2,000.00

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 Prepared by: Approved by:

Lupon Secretary Lupon Chairman

Signature over printed name Signature over printed name
Date : Date :

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LTIA FORM 07-B: LUPONG TAGAPAMAYAPA PROFILE

Name of the Lupong Tagapamayapa BARANGAY FVR

Punong Barangay HON. CARLITO DC. TEBOSO
City/Municipality NORZAGARAY Barangay Logo Here
Province BULACAN
Region 3
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
Roman S. Belarmino Jr. Name Name Name Hon. Carlito Dc. Teboso
Feb. 4, 2021 Date of Birth Date of Birth Date of Birth Feb. 26, 1970
2018-at present 2018-at present 2018-at present 2018-at present 2018-upto present
High School Graduate High School Graduate College Undergrad High School Graduate Vocational Graduate

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 Reynald Alejo Umbaña
Date of Birth Date of Birth Date of Birth Date of Birth May 24, 1989

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 2018-at present 2018-at present 2018-at present 2018-at present March 1, 2020-at Present
High School Graduate High School Graduate High School Graduate High School Graduate High School Graduate

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LTIA FORM 07-B: LUPONG TAGAPAMAYAPA PROFILE

Name of the Lupong Tagapamayapa BARANGAY FVR

Punong Barangay HON. CARLITO DC. TEBOSO
City/Municipality NORZAGARAY Barangay Logo Here
Province BULACAN
Region 3
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

Roman S. Belarmino Jr. Editha B. Lopez Lucia F. Rodelas Susan N. Claudio Agnes N. Limboc Magdalena N. Bucod
Feb. 4, 2021 Jan. 18, 1964 Aug. 26, 1973 May 20, 1966 Oct. 28, 1970 June 3, 1950
2018-to present 2018-to present 2018-to present 2018-to present 2018-to present 2018-to present
High School Graduate High School Graduate College Undergrad High School Graduate High School Graduate High School Graduate

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

Lida D. Murillo Elisa F. Barom Erlinda Gatela Miranda Lina Bonete Agustin Imelda C. Alforte Phoedenel Oro Abelarde
Nov. 6, 1972 March 10, 1958 Nov. 1, 1962 Jan. 22, 1972 Nov.28, 1965 April 17, 1960-2021
2018-to present 2018-to present 2018-to present 2018-to present 2018-to present 2018-2021

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 High School Graduate High School Graduate High School Graduate High School Graduate High School Graduate College undergrad

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 C.Y. 2016 LUPONG TAGAPAMAYAPA INCENTIVES AWARD (LTIA)
LTIA FORM 07-B: LUPONG TAGAPAMAYAPA PROFILE

Name of the Lupong Tagapamayapa BARANGAY FVR

Punong Barangay HON. CARLITO DC. TEBOSO
City/Municipality NORZAGARAY Barangay Logo Here
Province BULACAN
Region 3
LUPONG TAGAPAMAYAPA PROFILE

Group Photo of the Lupong Tagapamayapa

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