7/25/2019 Certificate to File Action- Sample Form

1/1

Republic of the PhilippinesProvince of _____CITY OF ______

Barangay ______OFFICE OF THE !PO"# T$#$P$%$Y$P$

Barangay Case "o& ______For' Collection of (u) of

%oney

%r& BCo)plainant

* against *

%r& $Respon+ent

CERTIFICATION TO FILE ACTION

This is to certify that'

,& There has been a personal confrontation bet-een the parties before the

Punong Barangay.Pang/at ng Tagapag/asun+o0

1& $ settle)ent -as reache+0

2& The settle)ent has been repu+iate+ in a state)ent s-orn to before thePunong Barangay by _______ on groun+ of non3 ful4ll)ent of __________ to paythe principal a)ount plus interest on the +ay agree+ upon in the settle)ent0an+ 5state the reason6

7& Therefore8 the correspon+ing co)plaint for the +ispute )ay no- be 4le+ inCourt&

This __ +ay of 9ece)ber8 ___ at ________8 Philippines&

NAME OF SECRETARY

upon (ecretary

$tteste+'

NAME OF PUNONG BARANGAY

upon Chair)an