Republika ng Pilipinas

Lalawigan ng Aurora
Bayan ng Baler
BARANGAY CALABUANAN
Area 4, Barangay Calabuanan, Baler, Aurora, 3200
Email: sb.calabuanan2018@gmail.com Or Call: +639171054342

Tanggapan ng Punong Barangay

CTRL NO. _________________________

BARANGAY PROTECTION ORDER

NAME OF RESPONDENT : _________________________________________________________
ADDRESS : __________________________________________________________________________

ORDER
______________________________________________________________________________
______________________________________________________________________________
__________________________________________________

After having heard the application and the witness and evidence, the undersigned hereby
issues this BPO ordering you to immediate cease and desist from causing or Threatening to
Couse physical harm to
____________________________________________________________ and / or her child /
children namely;

______________________________________________________________________________
______________________________________________________________________________
__________________________________________________

This BPO is effective for fifteen (15) days from receipt.

VIOLATION OF THIS ORDER IS PUNISHABLE BY LAW

Hon. DAVID P. OROLFO,

JR.
Punong Barangay
Copy received by: __________________________________________
Signature over printed name

Date received: _____________________________________________

Served by: _________________________________________________

Signature over printed name

ATTESTATION

(In case the Punong Barangay is unavailable)

I hereby attest that Punong

Barangay_____________________________________________________was unavailable to action
Application for Barangay protection Order No. _______________ filled by
_______________________________________________on _____________________________ at

Punong Barangay: David P. Orolfo, Jr. Kagawad: Myreen F. Pimentel; Harold N. Mingua; Dorita G.
Pimentel; Nelda S. Sia; Ronnie R. Fernando; Marlene R. Hugo; Aries S. Mercado; SK Chairperson:
Judith A. Sindac; Kalihim: Loina Joy C. Lopez; Ingat-Yaman: Rodelyn E. Dela Torre
Email: sb.calabuanan2018@gmail.com Or Call: +639171054342
 Republika ng Pilipinas
Lalawigan ng Aurora
Bayan ng Baler
BARANGAY CALABUANAN
Area 4, Barangay Calabuanan, Baler, Aurora, 3200
Email: sb.calabuanan2018@gmail.com Or Call: +639171054342

Tanggapan ng Punong Barangay

____________________ a.m./p.m. and issue such order. (date)
(time)

___________________________________________
Barangay Kagawad

Punong Barangay: David P. Orolfo, Jr. Kagawad: Myreen F. Pimentel; Harold N. Mingua; Dorita G.
Pimentel; Nelda S. Sia; Ronnie R. Fernando; Marlene R. Hugo; Aries S. Mercado; SK Chairperson:
Judith A. Sindac; Kalihim: Loina Joy C. Lopez; Ingat-Yaman: Rodelyn E. Dela Torre
Email: sb.calabuanan2018@gmail.com Or Call: +639171054342