Katarungang Pambarangay Form No.

10

Republic of the Philippines

Province of _______________
City / Municipality of _______
Barangay _________________

OFFICE OF THE PUNONG BARANGAY

NOTICE OF CONSTITUTION OF PANGKAT

TO: _______________________ __________________________

_______________________ __________________________

Complainant/s Respondent/s

You are hereby required to appear before me on the ________ day of

_____________ 20 _____ , at _____________ o’clock in the morning / afternoon for the
constitution of the Pangkat ng Tagapagkasundo which shall conciliate your dispute.
Should you fail to agree to the Pangkat membership or to appear on the aforesaid date for
the constitution of the Pangkat, I shall determine the membership thereof by drawing lots.

This __________ day of ______________ , 20 ___________ .

_____________________
Punong Barangay

Notified this ____________ day of ________ , 20 _____ .

_______________________ ______________________

_______________________ ______________________

Complainant/s Respondent/s

Received by Respondent/s Representative/s

________________________ _______________________

________________________ _______________________

(Signature) (Date)