BJ Form No.

REPUBLIC OF THE PHILIPPINES

CITY OF MANILA
BARANGAY _________, ZONE _____, DISTRICT_____

OFFICE OF THE LUPON TAGAPAMAYAPA

_____________________________ Barangay Case No. _________

_____________________________ For: _____________________
Complainant/s

-against-

____________________________
____________________________
Respondent/s

x-- -- -- -- -- -- -- -- -- -- -- -- -- -- x

SUMMON

TO: ______________________
Respondent/s

You hereby summoned to appear before me in person, together with your witnesses, on
the ____ day of ________________, 2018, at _______ o’clock in the morning/afternoon
to answer to a complaint made before me, copy of which is attached hereto, for
mediation/conciliation of your dispute with complainant/s.

This is also to warn you that if you refuse to appear in obedience to this summon, you
may be barred from filing any counterclaim arising from said complaint.

FAIL NOT or else face punishment as contempt of court.

This ____day of ______________________ , 2018.

__________________________________
Punong Barangay