KP Form 22

Republic of the Philippines

Province of National Capital Region
CITY/MUNICIPALITY OF MAKATI
Barangay Bel Air Makati
OFFICE OF THE LUPONG TAGAPAMAYAPA
JUNJUN B. BINDOY,
No. 1234xxx
Complainant,

Barangay Case
For: Breach of Contract
and Collection for a Sum
of Money

- - against - -

BENNY B. PENOY,
Respondent.
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
Pangat; and
4. Therefore, the corresponding complaint for the dispute may
now be filed in court/ government office.

___________________________________
Pangkat Secretary
Attested by:
____________________________________

KP Form 22

Pangkat Chairman