Republic of the Philippines

Barangay Bagong Silangan

Quezon City

OFFICE OF THE LUPONG TAGAPAMAYAPA

________________________ Barangay Case No. ______________

________________________ For: __________________________
Complainant/s ______________________________

-against-

________________________
________________________
Respondent/s

CERTIFICATE TO FILE ACTION

This is to certify that:

1. This complaint was filed on ____________________________________.

2. There has been no personal confrontation between the parties before the Punong
Barangay because the respondent was absent and that mediation failed.
3. The Pangkat Tagapagkasundo was constituted but there has been no personal
confrontation before the Pangkat likewise did not result into a settlement because the
respondent was absent.
4. Therefore, the corresponding complaint for the dispute may now be filed in
court/government office.

This _________ day of ___________, 20____.

_____________________________
Pangkat Secretary

Attested by:

___________________________
Pangkat Chairman