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BCPC FORM NO.

Republic of the Philippines


Province of___________________
City/Municipality_____________________
Barangay___________________

BARANGAY COUNCIL FOR THE PROTECTION OF CHILDREN (BCPC)

COMPLAINANT FORM

______________________________________ ____________________________________
______________________________________ against ____________________________________
______________________________________ ____________________________________
Complainant CICL

______________________________________ ____________________________________
______________________________________ ____________________________________
Address Address

COMPLAINT

I/ We hereby file this complaint against the above name respondent/s for violating my/our rights and interest in
the following manner:
_________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

WHEREFORE, I/We pray that the following relief/s be granted to me/ us in accordance with the law and/ or
equity.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Page 1 of 2 RJJWC Caraga/ R.Tagnipez


BCPC FORM NO.2

Done this _____ day of _____________________, 20____

____________________________________

Complainant’s Name/ Signature

_______________________________ __________________________________

Name and Signature of CICL Name and Signature of Parents/Guardian

Received and filed this ______ day of _______________________, 20_______

______________________________________

Name and Signature of Punong Barangay

Page 2 of 2 RJJWC Caraga/ R.Tagnipez

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