Republic of the Philippines

Province of Zamboanga del Norte

Municipality of Polanco
BARANGAY NEW SICAYAB
-o0o-

OFFICE OF THE LUPONG TAGAPAMAYAPA

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

Barangay Case No. ___________________________

For: ________________________________________

-Complainant-
-vs-

-Respondent-

CERTIFICATE TO FILE ACTION

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

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 Tagapagsundo was constituted but the personal confrontation

before the Pangkat likewise did not result into settlement.

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

Issued this _____ day of _____________________ 20__ at Barangay New Sicayab,

Polanco, Zamboanga del Norte.

Pangkat Secretary Pangkat Member

Pangkat Chairman