KP FORM # 1: NOTICE TO CONSTITUTE THE LUPON

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 Other 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 Lupong Tagapamayapa of this Barangay. The persons I am
considering for appointment are the following:

1. _________________ 13. _________________

2. _________________ 14. _________________
3. _________________ 15. _________________
4. _________________ 16. _________________
5. _________________ 17. _________________
6. _________________ 18. _________________
7. _________________ 19. _________________
8. _________________ 20. _________________
9. _________________ 21. _________________
10. _________________ 22. _________________
11. _________________ 23. _________________
12. _________________ 24. _________________
25. _________________

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 mindedness 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 and of their

opposition to or endorsement of any or all the proposed members or

K A TA R U N G A N G PA M B A R A N G AY 83
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 # 2: APPOINTMENT LETTER

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 Lupong Tagapamayapa of this Barangay effective upon taking your
oath of office and until a new Lupon is constituted on the third year
following your appointment.

__________________
Punong Barangay

ATTESTED:
__________________
Barangay Secretary

84 A HANDBOOK
KP FORM # 3: NOTICE OF APPOINTMENT

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 you have been appointed by the Punong

Barangay as a MEMBER OF THE LUPONG 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

K A TA R U N G A N G PA M B A R A N G AY 85
KP FORM # 4: LIST OF APPOINTED LUPON MEMBERS

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 Lupong

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: The list shall be posted in three (3) conspicuous places

in the barangay for the duration of the terms of office of those named
above.

WARNING: Tearing or defacing this notice shall be subject to

punishment according to law.

86 A HANDBOOK
KP FORM # 5: LUPON MEMBER OATH STATEMENT

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 II, Local Government Code of

1991 (Republic Act No. 7160), I _______________, being duly
qualified and having been duly appointed MEMBER of the Lupong
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

K A TA R U N G A N G PA M B A R A N G AY 87
KP FORM # 6: WITHDRAWAL OF APPOINTMENT

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

_________, 20 ____
(Date)

WITHDRAWAL OF APPOINTMENT

TO: _______________

After due hearing and with the concurrence of a majority of all the
Lupong 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 whichever is applicable and detail or specify the act/s or
omission/s constituting the ground/s for withdrawal.)

____________________________
Punong Barangay/Lupon Chairman

CONFORME (Signatures):

1. _________________ 7. _________________
2. _________________ 8. _________________
3. _________________ 9. _________________
4. _________________ 10. ________________
5. _________________ 11. ________________
6. _________________

Received this __________ day of _____________, 19____.

__________________
Signature

88 A HANDBOOK
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 # 7: COMPLAINANT’S FORM

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s ________________________
__________________________

— against —

__________________
__________________
Respondent/s

COMPLAINT

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

my/our rights and interests in the following manner:
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
THEREFORE, I/WE pray that the following relief/s be granted to me/
us in accordance with law and/or equity:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________

K A TA R U N G A N G PA M B A R A N G AY 89
Made this _______ day of ___________, 19____.

________________
Complainant/s

Received and filed this ________ day of __________, 19____.

___________________________
Punong Barangay/Lupon Chairman

KP FORM # 8: NOTICE OF HEARING

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

NOTICE OF HEARING
(MEDIATION PROCEEDINGS)

TO: ________________
________________
Complainant/s

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

_______, 19___ at ________ o’clock in the morning/afternoon for the
hearing of your complaint.

This ________ day of ____________, 19____.

____________________________
Punong Barangay/Lupon Chairman

Notified this ________ day of __________, 19____.

Complainant/s
_______________
_______________

90 A HANDBOOK
KP FORM # 9: SUMMON FOR THE RESPONDENT

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG 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 witnesses, on the _______ day of _________, 19___ 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 ____________, 19___.

_____________________________
Punong Barangay/Pangkat Chairman

K A TA R U N G A N G PA M B A R A N G AY 91
Back page

OFFICER’S RETURN

I served this summons upon respondent _________________________

on the ______ day of ______________, 19____, and upon respondent
___________________________ on the day of ________________,
19____, by:

(Write name/s of respondent/s before mode by which he/they was/were

served.)
Respondent/s
__________________________ 1. handing to him/them said
summons in person, or
__________________________ 2. handing to him/them said
summons and he/they refused to
receive it, or
__________________________ 3. leaving said summons at his/
their dwelling with __________
(name) a person of suitable age
and discretion residing therein,
or
__________________________ 4. leaving said summons at his/
their office/place of business
with ________, ( name) a
competent person in charge
thereof.

_____________
Officer

Received by Respondent/s representative/s:

___________________ __________________
Signature Date
___________________ __________________
Signature Date

92 A HANDBOOK
KP FORM # 10: NOTICE FOR CONSTITUTION OF PANGKAT

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

_________, 19____, 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 ____________, 19_____.

____________________
Punong Barangay

Notified this _________ day of _________, 19_____.

TO: __________________ ____________________

_________________ ____________________
Complainant/s Respondent/s

K A TA R U N G A N G PA M B A R A N G AY 93
KP FORM # 11: NOTICE TO CHOSEN PANGKAT MEMBER

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

NOTICE TO CHOSEN PANGKAT MEMBER

(Date)

TO: ________________

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

____________________________
Punong Barangay/Lupon Secretary

Received this ________ day of __________, 19_____.

______________
Pangkat Member

94 A HANDBOOK
KP FORM # 12: NOTICE OF HEARING (CONCILIATION PROCEEDINGS)

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE PUNONG BARANGAY

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 a hearing of
the above-entitled case.

This ________ day of ___________, 20____.

___________________
Pangkat Chairman

Notified this _____ day of __________, 19____.

Complainant/s Respondent/s
___________________ __________________
___________________ __________________

K A TA R U N G A N G PA M B A R A N G AY 95
KP FORM # 13: SUBPOENA LETTER

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

SUBPOENA

TO: ____________________ _________________________

____________________ _________________________

Witnesses

You are hereby commanded to appear before me on the ______ day of

_________, 19___, at ___________ o’clock, then and there to testify
in the hearing of the above-captioned case.

This ______ day of _________, 19____.

_______________________________
Punong Barangay/Pangkat Chairman
(Cross out whichever one is not applicable.)

96 A HANDBOOK
KP FORM # 14: AGREEMENT FOR ARBITRATION

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG 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 _________, 19____.

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 the consequences of such agreement.

_______________________________
Punong Barangay/Pangkat Chairman
(Cross out whichever one is not applicable.)

K A TA R U N G A N G PA M B A R A N G AY 97
KP FORM # 15: ARBITRATION AWARD

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG 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 _____________, 19____ at ______________.

______________________________
Punong Barangay/Pangkat Chairman *

__________________
Member

__________________
Member

ATTESTED:
___________________________
Punong Barangay/Lupon Secretary **
* To be signed by either, whoever made the arbitration award.
** To be signed by the Punong Barangay if the award is made by the
Pangkat Chairman, and by the Lupon Secretary if the award is made by
the Punong Barangay.

98 A HANDBOOK
KP FORM # 16: AMICABLE SETTLEMENT

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG 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 __________, 19_______.

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 consequence of such settlement.

______________________________
Punong Barangay/Pangkat Chairman

K A TA R U N G A N G PA M B A R A N G AY 99
KP FORM # 17: REPUDIATION

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

REPUDIATION

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 _____________, 19____.

Complainant/s Respondent/s
___________________ __________________
___________________ __________________

SUBSCRIBED AND SWORN TO before me this ________ day of

__________, 19____ at _____________.

100 A HANDBOOK
_____________________________________
Punong Barangay/Pangkat Chairman/Member

Received and filed * this ______ day of ______________, 19_____.

____________________
Punong Barangay
* Failure to repudiate the settlement or the arbitration agreement within
the time limits respectively set (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 said grounds.

K A TA R U N G A N G PA M B A R A N G AY 101
KP FORM # 18: NOTICE OF HEARING FOR COMPLAINANT

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG 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 _________, 19____, at ________ o’clock in the
morning/afternoon to explain why you failed to appear for mediation/
conciliation scheduled on _____________, 19____ and why your
complaint should not be dismissed, a certificate to bar the filing of your
action on 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 ___________, 19____.

_____________________________
Punong Barangay/Pangkat Chairman
(Cross out whichever is not applicable.)

Notified this _________ day of ________, 19_____.

102 A HANDBOOK
Complainant/s
__________________
__________________

Respondent/s
__________________
__________________

K A TA R U N G A N G PA M B A R A N G AY 103
KP FORM # 19: NOTICE OF HEARING FOR RESPONDENT

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

NOTICE OF HEARING
(RE: FAILURE TO APPEAR)

TO: _______________
_______________
Respondent/s

You are hereby required to appear me/the Pangkat on the _______ day
of ____________, 19____, at __________ o’clock in the morning/
afternoon to explain why you failed to appear for mediation/
conciliation scheduled on ____________, 19___ and why your
counterclaim (if any) arising from the complaint should not be
dismissed, a certificate to bar the filing of said counterclaim 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 _________, 19_____.

_____________________________
Punong Barangay/Pangkat Chairman
(Cross out whichever is not applicable.)

Notified this ________ day of _____________, 19____.

104 A HANDBOOK
Respondent/s: Complainant/s:
____________________ ______________________
____________________ ______________________

KP FORM # 20: CERTIFICATION TO FILE ACTION (FROM LUPON

SECRETARY)
Republic of the Philippines
Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

CERTIFICATION 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 ground of
______________; and
4. Therefore, the corresponding complaint for the dispute may now be
filed in court/government office.

This _________ day of __________, 19____.

___________________
Lupon Secretary

Attested:
__________________
Lupon Chairman

K A TA R U N G A N G PA M B A R A N G AY 105
KP FORM # 21: CERTIFICATION TO FILE ACTION (FROM PANGKAT
SECRETARY)
Republic of the Philippines
Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

CERTIFICATION 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 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 in court/government office.

This _________ day of _________, 19_____.

_________________
Pangkat Secretary

Attested by:
_________________
Pangkat Chairman

106 A HANDBOOK
KP FORM # 22: CERTIFICATION TO FILE ACTION

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

CERTIFICATION TO FILE ACTION

This is to certify that:

1. There was 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.

_________________
Pangkat Secretary

Attested by:
_________________
Pangkat Chairman

K A TA R U N G A N G PA M B A R A N G AY 107
KP FORM # 23: CERTIFICATION TO BAR ACTION

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

CERTIFICATION TO BAR ACTION

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

to the Order dated ______________, for complainant/s
_______________ (name) and ______________ (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 ______________, 19____.

_____________________________
Lupon Secretary/Pangkat Secretary

Attested:
________________________________
Lupon Chairman/Pangkat Chairman

IMPORTANT: If Lupon Secretary makes the certification, the Lupon

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

108 A HANDBOOK
KP FORM # 24: CERTIFICATION TO BAR COUNTERCLAIM

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

CERTIFICATION TO BAR COUNTERCLAIM

This is to certify that after prior 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/their counterclaim (if any) arising from the complaint in court/
government office.

This ____________ day of _________, 19___.

______________________________
Lupon Secretary/Pangkat Secretary

Attested:
____________________________
Lupon Chairman/Pangkat Chairman

IMPORTANT: If Lupon Secretary makes the certification, the Lupon

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

K A TA R U N G A N G PA M B A R A N G AY 109
KP FORM # 25: MOTION FOR EXECUTION

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

MOTION FOR EXECUTION

Complainant/s/Respondent/s state as follows:

1. On _____________ (Date) the parties in this case signed an
amicable settlement/received the arbitration award rendered by the
Lupon/Chairman/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 Chairman 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 request that the
corresponding writ of execution be issued by the Lupon Chairman in
this case.

_______________
(Date)
_______________________
Complainant/s/Respondent/s

110 A HANDBOOK
KP FORM # 26: NOTICE OF HEARING (RE: MOTION FOR EXECUTION)

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG 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 _________ day of

_________ 19____ at _________ o’clock in the morning/afternoon/
evening 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 Chairman

Notified this ________ day of ___________, 19____.

_____________________ ____________________
(Signature) (Signature)
Complainant/s Respondent/s

K A TA R U N G A N G PA M B A R A N G AY 111
KP FORM # 27: NOTICE OF EXECUTION

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

___________________ Barangay Case No. __________

___________________ For: ______________________
Complainant/s _________________________
__________________________

— against —

__________________
__________________
Respondent/s

NOTICE OF EXECUTION

WHEREAS, on ______________(date), an amicable 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 Lupong Tagapamayapa and by
virtue of the powers vested in 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) upon 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.

112 A HANDBOOK
Signed this _________ day of ___________, 19____.

___________________
Punong Barangay

Copy furnished:
____________________ ___________________
____________________ ___________________
Complainant/s Respondent/s

K A TA R U N G A N G PA M B A R A N G AY 113
KP FORM # 28: MONTHLY TRANSMITTAL OF FINAL REPORTS

Republic of the Philippines

Province of __________
CITY/MUNICIPALITY OF ______________
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA

OFFICE OF THE BARANGAY CAPTAIN

____________________, 20____
Date

MONTHLY TRANSMITTAL OF FINAL REPORTS

To: City/Municipal Judge

______________________
(City/Municipality)

Enclosed herewith are the final reports of settlement of disputes and

arbitration awards made by the Barangay Captain/ Pangkat
Tagapagkasundo in the following cases:

Barangay Case No. TITLE

(Complainant, et al vs. Respondent, et al)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

____________________________
(Clerk of Court)

IMPORTANT: Lupon/Pangkat Secretary shall transmit not later than

the first five days of each month the final reports for preceding month.

114 A HANDBOOK