KATARUNGANG

PAMBARANGAY
FORMS
KP FORM NO. 1

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE PUNONG BARANGAY

____________________, 20____

NOTICE TO CONSTITUTE THE LUPON

To All Barangay Members and All Persons Concerned:

In compliance with Section 1 (a). Chapter 7, Title One, Book III, Local
Government Code of 1991 (Republic Act No. 7160), of the Katarungang
Pambarangay Law, notice is hereby given to constitute the Lupon Tagapamayapa
of this Barangay. The persons I am considering for appointment are the
following:

1) ______________________ 10) _____________________ 19) ______________________

2) ______________________ 11) _____________________ 20) ______________________
3) ______________________ 12) _____________________ 21) ______________________
4) ______________________ 13) _____________________ 22) ______________________
5) ______________________ 14) _____________________ 23) ______________________
6) ______________________ 15) _____________________ 24) ______________________
7) ______________________ 16) _____________________ 25) ______________________
8) ______________________ 17) _____________________
9) ______________________ 18) _____________________

They have been chosen on the basis of their suitability for the task of
conciliation considering their integrity, impartiality, independence of mind, sense
of fairness and reputation for probity in view of their age, social standing in the
community, tact, patience, resourcefulness, flexibility, open mindness and other
relevant factors. The law provides that only those actually residing or working in
the barangay who are not expressly disqualified by law are qualified to be
appointed as Lupon members.

All persons are hereby enjoined to immediately inform me of their

opposition to or endorsement of any or all of the proposed members or
recommend to me other persons not included in the list but not later than the
________ day of __________ 20______ (the last day for posting this notice).

_________________________
Punong Barangay

IMPORTANT : This notice is required to be posted in three (3) conspicuous

places in the barangay for at least three (3) weeks.

WARNING : Tearing or defacing this notice shall be subject to punishment

according to law.
KP FORM NO. 2

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE PUNONG BARANGAY

____________________, 20____
(Date)

APPOINTMENT

TO: _______________________

Pursuant to Chapter 7, Title One Book III, Local Government Code

of 1991 (Republic Act No. 7160), you are hereby appointed MEMBER of
the Lupon Tagapamayapa of this Barangay effective upon taking your oath
and until a new Lupon is constituted on the third year following your
appointment.

___________________________
Punong Barangay

ATTESTED:

________________________
Barangay Secretary
KP FORM NO. 3

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE PUNONG BARANGAY

____________________, 20____
(Date)

NOTICE OF APPOINTMENT

____________________________
____________________________
____________________________

Sir/Madam:

Please be informed that your have been appointed by the Punong

Barangay as a MEMBER OF THE LUPON TAGAPAMAYAPA effective upon
taking your oath of office, and until a new Lupon is constituted on the
third year following your appointment. You may take your oath of office
before the Punong Barangay on _________________________________.

Very truly yours,

________________________
Barangay Secretary
KP FORM NO. 4

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE PUNONG BARANGAY

____________________, 20____
(Date)

LIST OF APPOINTED LUPON MEMBERS

Listed hereunder are the duly appointed members of the Lupon

Tagapamayapa in this Barangay who shall serve as such upon taking
their oath of office and until a new Lupon is constituted on the third year
following their appointment.

1) ________________________ 11) __________________________

2) ________________________ 12) __________________________
3) ________________________ 13) __________________________
4) ________________________ 14) __________________________
5) ________________________ 15) __________________________
6) ________________________ 16) __________________________
7) ________________________ 17) __________________________
8) ________________________ 18) __________________________
9) ________________________ 19) __________________________
10) ________________________ 20) __________________________

_____________________________
Punong Barangay

ATTESTED:

_____________________________
Barangay/Lupon Secretary

IMPORTANT: This notice is required to be posted in three (3)

conspicuous places in the barangay for at least three (3) weeks.

WARNING: Tearing or defacing this notice shall be subject to

punishment according to law.
KP FORM NO. 5

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE PUNONG BARANGAY

OATH OF OFFICE

Pursuant to Chapter 7, Title One, Book III, Local Government Code

of 1991 (Republic Act No. 7160), I ____________________, being duly
qualified and having been duly appointed MEMBER of the Lupon
Tagapamayapa of this Barangay, do hereby solemnly swear (or affirm) that
I will faithfully and conscientiously discharge to the best of my ability my
duties and functions as such member and as member of the Pangkat ng
Tagapagkasundo, in which I may be chosen to serve; that I will bear true
faith and allegiance to the Republic of the Philippines; that I will support
and defend its Constitution and obey the laws, legal orders and decrees
promulgated by its duly constituted authorities; and that I voluntarily
impose upon myself this obligation without any mental reservation or
purpose of evasion.

SO HELP ME GOD. (In case of affirmation, the last sentence will be

omitted.)
____________________________
Member

SUBSCRIBED AND SWORN to (or AFFIRMED) before me this

________ day of ______________ 20_____.

______________________________
Punong Barangay
KP FORM NO. 6

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

____________________, 20____
(Date)

WITHDRAWAL OF APPOINTMENT

TO: ________________________

After due hearing and with the concurrence of a majority of all the
Lupon Tagapamayapa members of this barangay, your appointment as
member thereof is hereby withdrawn effective upon receipt hereof, on the
following ground/s:

 - incapacity to discharge the duties of your office as shown by

________________________________________________________________________
________________________________________________________________________
 - unsuitability by reason of _______________________________________
________________________________________________________________________
________________________________________________________________________
(Check which ever is applicable and detail or specify the act/s or
omission/s constituting the ground/s for withdrawal.)

___________________________________
Punong Barangay/Lupon Chairperson
(Cross out whichever is not applicable)

CONFORME (Signatures)

1) ________________________ 11) __________________________

2) ________________________ 12) __________________________
3) ________________________ 13) __________________________
4) ________________________ 14) __________________________
5) ________________________ 15) __________________________
6) ________________________ 16) __________________________
7) ________________________ 17) __________________________
8) ________________________ 18) __________________________
9) ________________________ 19) __________________________
10) ________________________ 20) __________________________

Received this ______ day of _______________ 20____.

_____________________________
 (Signature)

NOTE:

The members of the Lupon conforming to the withdrawal must

personally affix their signatures or thumb marks on the pertinent spaces
above. The withdrawal must be conformed to by more than one-half of the
total number of members of the Lupon including the Punong Barangay
and the member concerned.
KP FORM NO. 7

Republic of the Philippines

Province of SORSOGON
CITY/MUNICIPALITY OF IROSIN
Barangay Buenavista

OFFICE OF THE LUPON TAGAPAMAYAPA

Eusebio Banua, Barangay Case No. 23

In relation to Brgy. Case No. 20
For: Threat
Complainant/s ____________________________
____________________________
-Against-

Jorge G. Andes
Respondent/s

COMPLAINT

I/WE hereby complain against above named respondent/s for violating

my/our rights and interest in the following manner:

Kay san March 16,2019 (4:15 an hapon),nag-iimud ako san nagtatrabaho

san gate ni Enrique Fuensalida,insabihan niya ako na “ikaw,matabilon
ka, ayuton ta ikaw ”nan induro-duro nya ako.

Made this 18th day of March 2019.

Eusebio Banua
Complainant/s

Received and filed this 18th day of March 2019.

Hon. Danilo N. Galoso

Punong Barangay/Lupon Chairperson
(Cross out whichever is not applicable)
KP FORM NO. 8

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

NOTICE OF HEARING
(MEDIATION PROCEEDINGS)

TO: ________________________

________________________
Complainant/s

You are hereby required to appear before me on the _____ day of

_______________ 20_____ at __________________ o’clock in the
morning/afternoon for the hearing of your complaint.

This ______ day of _______________ 20________.

___________________________
Punong Barangay

Notified this ________ day of ________________ 20_____.

Complainant/s

________________________________________

________________________________________

________________________________________
KP FORM NO. 9

Republic of the Philippines

Province of Sorsogon
CITY/MUNICIPALITY OF IROSIN
Barangay Buenavista

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. ____

_______________________ For: __________________________
Complainant/s ____________________________
____________________________

-Against-
______________________
______________________
Respondent/s

SUMMONS

TO: ______________________ _____________________________

______________________ _____________________________

Respondents

You are hereby summoned to appear before me in person together

with your witness, on the ____ day of ______, 2020 at _______ o’clock in the
morning/afternoon, then and there to answer to a complaint made before
me, copy of which is attached hereto, for mediation/conciliation of your
dispute with complainant/s.

You are hereby warned that if you refuse or willfully fail to appear in
obedience to this summons, you may be barred from filing any
counterclaim arising from said complaint.

FAIL NOT or else, face punishment as for contempt of court.

This ____ day of _______________ 2020.

DANILO N. GALOSO
Punong Barangay/Pangkat Chairperson
(Cross out whichever is not applicable)
KP FORM NO. 9, Page 2

OFFICER’S RETURN

I served this summon upon respondent ________________ on the

_____________ day of ____________________ 20_______ and upon respondent
________________________________ on the _________ day of
____________________ 20________, by: (Write name/s of respondent/s before
mode by which he/they was/were served.)

Respondent/s

______________________________________________ 1) handling to
him/her/them said summons in person, or

_______________________________________________ 2) handling to him/her

said summons and he/she/they refused to receive it, or

_______________________________________________ 3) leaving said summons

at his/her/their dwelling with

________________________________ A person of suitable age and discretion

(Name)
therein, or

_______________________________________________ 4) leaving said summons

at his/her/their office/place of business with
______________________________, A competent person in charge thereof.
(Name)

________________________
Officer

Received by Respondent/s/representative/s:

_______________________________ _______________________________
(Signature) (Date)

_______________________________ _______________________________
(Signature) (Date)
KP FORM NO. 10

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE PUNONG BARANGAY

NOTICE FOR CONSTITUTION OF PANGKAT

TO: _____________________________ ___________________________________

_____________________________ ___________________________________
Complainant/s Respondent/s

You are hereby required to appear before me on the _______ day of

_________________ 20______ at ________o’clock in the morning/afternoon for
the constitution of the Pangkat ng Tagapagkasundo which shall conciliate
your dispute. Should you fail to agree on the Pangkat membership or to
appear on the aforesaid date for the constitution of the Pangkat, I shall
determine the membership thereof by drawing lots.

This ________ day of __________________ 20_____.

_________________________________ ___________________________________

_________________________________ ___________________________________
Complainant/s Respondent/s
KP FORM NO. 11

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________

-Against-
______________________
______________________
Respondent/s

NOTICE TO CHOSEN PANGKAT MEMBER

__________________, 20______
Date
_____________

TO: ___________________________

Notice is hereby given that you have been chosen member of the
Pangkat ng Tagapagkasundo to amicably conciliate the dispute
between the parties in the above-entitled case.

___________________________________
Punong Barangay/Lupon Secretary
(Cross out whichever is not applicable)

Received this _______ day of ________________ 20_____

___________________________________
Pangkat Member
KP FORM NO. 12

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

TO: _____________________________ ______________________________

_____________________________ ______________________________
Complainant/s Respondent/s

NOTICE OF HEARING
(CONCILIATION PROCEEDINGS)

You are hereby required to appear before the Pangkat on the

___________ day of _________________ 20______ at ___________ o’clock for
hearing of the above-entitled case.

This ________ day of ____________________ 20_______.

___________________________
Pangkat Chairperson

Notified this ________ day of ______________ 20______.

Complainant/s Respondent/s

_______________________________ _______________________________

_______________________________ _______________________________
KP FORM NO. 13

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________

-Against-
______________________
______________________
Respondent/s

S U B P O E N A

TO: _______________________________ ________________________________

_______________________________ ________________________________

WITNESSES

You are hereby commanded to appear before me on the __________

day of __________________ 20______ at _________ o’clock, then and there to
testify in the hearing of the above-captioned case.

This __________ day of ___________________ 20______.

_____________________________________
Punong Barangay/Pangkat Chairperson
(Cross out whichever is not applicable)
KP FORM NO. 14

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________

-Against-
______________________
______________________
Respondent/s

AGREEMENT FOR ARBITRATION

We hereby agree to submit our dispute for arbitration to the Punong

Barangay/Pangkat ng Tagapagkasundo (Please cross out whichever is not
applicable) and bind ourselves to comply with the award that may be
rendered thereon. We have made this agreement freely with a full
understanding of its nature and consequences.

Entered into this ________ day of __________________, 20________.

Complainant/s Respondent/s

_______________________________ _________________________________
_______________________________ _________________________________

ATTESTATION:

I hereby certify that the foregoing Agreement for Arbitration was

entered into by the parties freely and voluntarily, after I had explained to
them the nature and consequences of such agreement.

______________________________________
Punong Barangay/Pangkat Chairperson
(Cross out whichever is not applicable)
KP FORM NO. 15

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. ______________

_______________________ For: _____________________________
Complainant/s _____________________________
_____________________________
-Against-
_______________________
_______________________
Respondent/s

ARBITRATION AWARD

After hearing the testimonies given and careful examination of the

evidence presented in this case, award is hereby made as follows.

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
______________________________________________________________________

Made this ________ day of _________________ 20______ at

___________________________.

______________________________________
Punong Barangay/Pangkat Chairperson
(Cross out whichever is not applicable)

______________________________________
Member

______________________________________
Member

ATTESTED:

___________________________________
Punong Barangay/Lupon Secretary**

* To be signed by either of the two, whoever made the arbitration award

** To be signed by the Punong Barangay if the award is made by the Pangkat
Chairperson, and by the Lupon Secretary if the award is made by the Punong
Barangay.
KP FORM NO. 16

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________
-Against-
_______________________
_______________________
Respondent/s

AMICABLE SETTLEMENT

We, complainant/s and respondent/s in the above-captioned case,

do hereby agree to settle our dispute as follows:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
___________________________________________________________________
and bind ourselves to comply honestly and faithfully with the above terms
of settlement.

Entered into this ________ day of __________________ 20_______.

Complainant/s Respondent/s

_______________________________ _________________________________
_______________________________ _________________________________

ATTESTATION
I hereby certify that the foregoing amicable settlement was entered
into by the parties freely and voluntarily, after I had explained to them the
nature and consequences of such settlement.

_____________________________________
Punong Barangay/Pangkat Chairperson
KP FORM NO. 17

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________
-Against-
_______________________
_______________________
Respondent/s

R E P U D I A T I O N

I/WE hereby repudiate the settlement/agreement for arbitration on

the ground that my/our consent was vitiated by:

(Check out whichever is applicable)

 - Fraud. (State details) _________________________________________

______________________________________________________________
______________________________________________________________
_________________________________________________________

 - Violence. (State details) _______________________________________

______________________________________________________________
______________________________________________________________
_________________________________________________________

 - Intimidation. (State details) ___________________________________

______________________________________________________________
______________________________________________________________
_________________________________________________________

This ________ day of ____________________ 20_______.

Complainant/s Respondent/s

_______________________________ _________________________________

_______________________________ _________________________________

_______________________________ _________________________________

SUBCRIBED AND SWORN TO before me this ______________ day of

___________________ 20______ at ___________________________.

______________________________________________
 Punong Barangay/Pangkat Chairperson/Member
(Cross out whichever is not applicable)

Received and filed* this _____________ day of ___________________

20_________.

__________________________
Punong Barangay

* Failure to repudiate the settlement or the arbitration agreement

within the time limit respectively set in ten (10) days from the date of
settlement and five (5) days from the date of arbitration agreement shall
be deemed a waiver of the right to challenge on the said grounds.
KP FORM NO. 18

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________

-Against-
______________________
______________________
Respondent/s

NOTICE OF HEARING
(RE: FAILURE TO APPEAR)

TO: ____________________________
____________________________
Complainant/s

You are hereby required to appear before me/the Pangkat on the

___________ day of __________________ 20_________ at _______________o’clock
in the morning/afternoon to explain why you failed to appear for
mediation/conciliation scheduled on ______________________, 20________
and why your complaint should not be dismissed, a certificate to bar the
filing of your action in court/government office should not be issued, and
contempt proceedings should not be initiated in court for willful failure or
refusal to appear before the Punong Barangay/Pangkat ng
Tagapagkasundo.

This _______ day of __________________ 20_________

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

Notified this _______ day of _______________________ 20_______.

Complainant/s

____________________________________

____________________________________
 Respondent/s

____________________________________

____________________________________

KP FORM NO. 19

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________

-Against-
______________________
______________________
Respondent/s

NOTICE OF HEARING
(RE: FAILURE TO APPEAR)

TO: ____________________________
____________________________
Complainant/s

You are hereby required to appear before me/the Pangkat on the

_______________ day of __________________, 20_________ at
_______________o’clock in the morning/afternoon to explain why you failed
to appear for mediation/conciliation scheduled on ______________________,
20________ and why your counterclaim (if any) should not be dismissed, a
certificate to bar the filing of your action in court/government office
should not be issued, and contempt proceedings should not be initiated in
court for willful failure or refusal to appear before the Punong
Barangay/Pangkat ng Tagapagkasundo.

This _______ day of __________________ 20_________

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

Notified this _______ day of _______________________ 20_______.

Complainant/s Respondent/s

_________________________________ ________________________________
_________________________________ ________________________________
KP FORM NO. 20

Republic of the Philippines

Province of Sorsogon
CITY/MUNICIPALITY OF IROSIN
Barangay Buenavista

OFFICE OF THE LUPON TAGAPAMAYAPA

Noel Mateos Sagasayan Barangay Case No. 62

_______________________ For: Trespassing
Complainant/s ____________________________
____________________________

-Against-
Democrito Guban
______________________
Respondent/s

CERTIFICATE TO FILE ACTION

This is to certify that:

1) There has been a personal confrontation between the parties before

the Punong Barangay/Pangkat ng Tagapagkasundo;

2) A settlement was reached;

3) The settlement has been repudiated in a statement sworn to before

the Punong Barangay by _________________________________ on the
ground of __________________________________________________; and

4) Therefore, the corresponding complaint for the dispute may now be

filed in court/government office.

This _________ day of __________________ 20_______.

_________________________
Lupon Secretary

Attested:

___________________________
Lupon Chairperson
KP FORM NO. 20-A

Republic of the Philippines

Province of Sorsogon
CITY/MUNICIPALITY OF IROSIN
Barangay Buenavista

OFFICE OF THE LUPON TAGAPAMAYAPA

Barangay Case No. 7

LEONIDA FUTO For:

Complainant/s Trespassing,Malicious
Mischief, Threat,
Damage to Properties,

-Against-

JOSEPH GILE
Respondent/s

CERTIFICATE TO FILE ACTION

This is to certify that:

1) There has no personal confrontation between the parties before the

Punong Barangay but mediation failed;

2) The Pangkat ng Tagapagkasundo was constituted but the personal

confrontation before the Pangkat likewise did not result into a
settlement; and

3) Therefore, the corresponding complaint for the dispute may now be

filed into court/government office.

This 26th day of February 2020.

MARY JANE D. FUENSALIDA

Pangkat Secretary

Attested:

HON. RODOLFO F. BARRO

Pangkat Chairman
KP FORM NO. 20-B

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 FILE ACTION

This is to certify that:

1) There has been a personal confrontation between the parties before

the Punong Barangay but mediation failed;

2) The Punong Barangay set the meeting of the parties for the
constitution of the Pangkat;

3) The respondent willfully failed or refused to appear without

justifiable reason at the conciliation proceedings before the Pangkat;
and

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 Chairperson
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.
KP FORM NO. 22

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 COUNTERCLAIM

This is to certify that after notice and hearing, the respondent/s

___________________________ (name) and _________________________ (name)
have been found to have willfully failed or refused to appear without
justifiable reason before the Punong Barangay/Pangkat ng
Tagapagkasundo and therefore respondent/s is/are barred from filing
his/her/their counterclaim (if any) arising from the complaint in
court/government office.

This ______ day of _______________________ 20_____.

___________________________________
Lupon Secretary/Pangkat Secretary
(Cross out whichever is not applicable)
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.
KP FORM NO. 23

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________

-Against-
______________________
______________________
Respondent/s

MOTION FOR EXECUTION

Complainant/s/Respondent/s state as follows:

1) On _____________________________ the parties in this case signed an

(date)
amicable settlement/received the arbitration award rendered by the
Lupon/Chairperson/Pangkat ng Tagapagkasundo;

2) The period of ten (10) days from the above-stated date has expired
without any of the parties filing a sworn statement of repudiation of
the settlement before the Lupon Chairperson a petition for
nullification of the arbitration award in court; and

3) The amicable settlement/arbitration award is now final and

executory.

WHEREFORE, Complainant/s/Respondent/s requests that the

corresponding writ of execution be issued by the Lupon Chairperson in
this case.

_______________________________
(Date)

_______________________________
Complainant/s/Respondent/s
KP FORM NO. 24

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________

-Against-
______________________
______________________
Respondent/s

NOTICE OF HEARING
(RE: MOTION FOR EXECUTION)

TO: _______________________________ __________________________________

_______________________________ __________________________________
Complainant/s Respondent/s

You are hereby required to appear before me on the _____________

day of ____________________ 20______ at _____________ o’clock in the
morning/afternoon for the hearing of the motion for execution, copy of
which is attached hereto, filed by
________________________________________.
(name of complainant/s/respondent/s)

_______________________
(Date)

___________________________________
Punong Barangay/Lupon Chairperson
(Cross out whichever is not applicable)

Notified this ________ day of _____________________ 20____________.

___________________________________ _________________________________
(Signature) (Signature)
Complainant/s Respondent/s
KP FORM NO. 25

Republic of the Philippines

Province of _____________________
CITY/MUNICIPALITY OF _________________
Barangay ________________________

OFFICE OF THE LUPON TAGAPAMAYAPA

_______________________ Barangay Case No. _____________

_______________________ For: ____________________________
Complainant/s ____________________________
____________________________

-Against-
______________________
______________________
Respondent/s

NOTICE OF EXECUTION

WHEREAS, on ______________________________________, an amicable

(Date)
settlement was signed by the parties in the above-entitled case (or an
arbitration award was rendered by the Punong Barangay/Pangkat ng
Tagapagkasundo);

WHEREAS, the terms and conditions of the settlement, the

dispositive portion of the award, read:

__________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________ .

The said settlement/award is now final and executory;

WHEREAS, the party obliged _____________________________________

(name)
has not complied voluntarily with the aforestated amicable
settlement/arbitration award, within the period of five (5) days from the
date of hearing on the motion for execution;

NOW, THEREFORE, in behalf of the Lupon Tagapamayapa and by

virtue of the powers vested upon me and the Lupon by the Katarungang
Pambarangay Law and Rules, I shall cause to be realized from the goods
and personal property of _______________________________________________
(name of party obliged)
the sum of ____________________________________________________________
(state amount of settlement or award)
in the said amicable settlement (or adjudged in the said arbitration
award), unless voluntary compliance of said settlement or award shall
have been made upon receipt hereof.

Signed this _______ day of ________________ 20_____.

_________________________
Punong Barangay

Copy furnished:

_________________________________ _________________________________

_________________________________ _________________________________
Complainant/s Respondent/s