KP Form No.

20-A
Republic of the Philippines
Province of Leyte
Municipality of Dagami
Barangay LOS MARTIRES

OFFICE OF THE LUPONG TAGAPAMAYAPA

Mrs. Lina D. Regis Barangay Case No. _______________

Mr. Joseph D. Regis For: SLIGHT PHYSICAL INJURIES WITH
Mrs. Marilou A.Regis DAMAGED OF PROPERTIES .
Brgy. Los Martires, Dagami, Leyte __________________________________
Complainant/s _________________________________
-between-

Mr. Boyet Laron and Hero Laron

Brgy. Talinhugon, Dagami, Leyte
Respondent/s

CERTIFICATION TO FILE ACTION

This is to certify that:

1. There has been personal confrontation between the parties before the Punong
Barangay but meadiation failed;
2. The Pangkat ng Tagapagkasundo was constituted but the personal confrontation
before the Pangkat likewise did not result into a settlement;
3. Therefore, the corresponding complaint for the dispute may now be filed in
court/government office.

This 0 05TH day of NOVEMBER, 2018.

DIGNA D. BARCALA
Pangkat Secretary

Attested:

MAURICIO B. VILLAMOR
Pangkat Chairman