ANNEX B

BJ Form No. 20-A

REPUBLIC OF THE PHILIPPINES

CITY OF ILOILO
BARANGAY CALAHUNAN, ZONE 1, DISCTRICT OF MANDURRIAO

OFFICE OF THE LUPON TAGAPAMAYAPA

Lino Bartolome
_______________________ Barangay Case No. ________
_______________________ For: Theft
For: Unlawful Detainer
Complaint/s,

-against-

Ace Corpus
__ ____________________
______________________

Respondent/s.

X-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- x

CERTIFICATION TO FILE ACTION

This is to certify that:

1. There has been a personal confrontation between the parties before the Punong Barangay
but mediation failed;

2. The Pangkat ng Tagapagkasundo was constituted but the personal confrontation before
the Pangkat likewise did not result into a settlement.

Therefore, the corresponding complaint for the dispute may now be filed in court/government
office.

This____
3rd day of _____________________,
January 2019
_____.

__________________________
Innocencio Cortez
Lupon Secretary

ATTESTED BY:

__________________________
Eva Mapendo
Pangkat Chairman