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    KP Form 21

    Uploaded by

    charles bautista

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    KP Form 21

    Uploaded by

    charles bautista
    2 views1 page

    Copyright

    © © All Rights Reserved

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    2 views1 page

    KP Form 21

    Uploaded by

    charles bautista

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    You are on page 1of 1

    KP FORM NO.

    21

    Republic of the Philippines


    Province of _____________________
    CITY/MUNICIPALITY OF _________________
    Barangay ________________________

    OFFICE OF THE LUPON TAGAPAMAYAPA

    _______________________ Barangay Case No. _____________


    _______________________ For: ____________________________
    Complainant/s ____________________________
    ____________________________

    -Against-
    ______________________
    ______________________
    Respondent/s

    CERTIFICATE TO BAR ACTION

    This is to certify that the above-captioned case was dismissed


    pursuant to the Order dated _______________________, for complainant/s’
    ________________________ (name) willful failure or refusal to appear for
    hearing before the Punong barangay/Pangkat ng Tagapagkasundo and
    therefore complainant/s is/are barred from filing an action in
    court/government office.

    This ________ day of ____________________ 20______.

    ____________________________________
    Lupon Secretary/Pangkat Secretary

    Attested:

    _____________________________________
    Lupon Chairperson/Pangkat Chairperson
    (Cross out whichever is not applicable)

    IMPORTANT: If Lupon Secretary makes the certification, the Lupon


    Chairperson attests. If the Pangkat Secretary makes the
    certification, the Pangkat Chairperson attests.

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