OFFICE OF THE LUPONG TAGAPAMAYAPA

________________________ Brgy.Case No.: ______________

Respondent/s For: _________________________

--against--

________________________
Complainant/s

CERTIFICATION TO FILE ACTION

This is to certify that :

1. There has been a personal confrontation between the parties before the Punong
Barangay;
2. A settlement was not reached;
3. Therefore, the corresponding complaint for the dispute may now be filed in
court/government office.

This ________ day of _________________ 2024.

______________________
Secretariat

Attested:

____________________________
Lupon Chairman