REPUBLIC OF THE PHILLIPINES

Barangay ________
City of Cebu


OFFICE OF THE LUPONG TAGAPAMAYAPA


____________________ Barangay Case no. ________
____________________ For:_______________
Complainants


-against-

_____________________
_____________________
Respondents


CERTIFICATION TO FILE ACTION

This is to certify that:

1. There has been no personal confrontation between the parties before the Punong
Barangay because the respondent was absent and that mediation failed.

2. 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.

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

This ____ day of ____ 2014.

________________________
Pangkat Secretary

Attested by:

_____________________ ______________________
Pangkat Chairperson Pangkat Member
_______________________
Pangkat Member

Noted by:

_______________________
Punong Barangay