7/29/2019 50843171 Certificate to File Action

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Republic of the Philippines

City of Manila

Barangay ______

OFFICE OF THE BARANGAY CAPTAIN

_________________________, Complainant,

- versus - Barangay Case No. _______________

For: ___________________________

__________________________,

Respondent.

x ------------------------------------------------------------------------------------ x

CERTIFICATE TO FILE ACTION

This is to certify that:

Complainant ________________________ (name) and respondent ________________________

(name) failed to or refuse to:

_______ Obey summons or to appear for hearing

_______ No settlement/conciliation was reached

_______ Settlement has been repudiated

And therefore, the corresponding complaint between the parties may now be filed in

court/government office concern.

This ___ day of ___________, 200__.

________________________________

Lupon/Pangkat Secretary

ATTESTED BY:

___________________________

Lupon/Pangkat Chaiman