KP Form No.

Republic of the Philippines

Province of Ilocos Sur
Municipality of Narvacan
BARANGAY ORENCE

OFFICE OF THE PUNONG BARANGAY

April 1, 2024
(Date)

NOTICE TO CONSTITUTE THE LUPON

To All Barangay Members and All Other Persons Concerned:

In compliance with Section 1 (a), Chapter, Title One, Book III, Local Government
Code of 1991 (Republic Act 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. TERESITA B. CABALBAG
2. RAYMUNDO N. TABUCOL SR.
3. DOMINADOR CORRALES
4. NANCY CABEBE
5. PRIMITIVO CALPITO
6. NESTOR ROLDAN
7. TERESITA POTENCION
8. EDITHA MENDOZA
9. ROGELIO CADILEÑA
10. LETTY TORRES

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 of their opposition to or

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

KRISTIAN PAUL C. SUPNET

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 Ilocos Sur
Municipality of Narvacan
BARANGAY ORENCE

April 1, 2024
(Date)

APPOINTMENT

TO: TERESITA B. CABALBAG

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.

KRISTIAN PAUL C.
SUPNET
Punong Barangay

ATTESTED:

CLARENCE C. CABALBAG
Barangay Secretary
KP Form No. 3

Republic of the Philippines

Province of Ilocos Sur
Municipality of Narvacan
BARANGAY ORENCE

April 1, 2024
(Date)

NOTICE OF APPOINTMENT

TERESITA B. CABALBAG

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
April 8, 2024.

Very truly yours,

CLARENCE C. CABALBAG
Barangay Secretary
KP Form No. 4

Republic of the Philippines

Province of Ilocos Sur
Municipality of Narvacan
BARANGAY ORENCE

OFFICE OF THE PUNONG BARANGAY

( 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. TERESITA B. CABALBAG
2. RAYMUNDO N. TABUCOL SR.
3. DOMINADOR CORRALES
4. NANCY CABEBE
5. PRIMITIVO CALPITO
6. NESTOR ROLDAN
7. TERESITA POTENCION
8. EDITHA MENDOZA
9. ROGELIO CADILEÑA
10. LETTY TORRES

KRISTIAN PAUL C. SUPNET

Punong Barangay

Attested:

Barangay /Lupon Secretary

IMPORTANT: This 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.
KP Form No. 5

Republic of the Philippines

Province of Ilocos Sur
Municipality of Narvacan
BARANGAY ORENCE
-o0o-

OFFICE OF THE PUNONG

BARANGAY
============================================
===================

OATH OF
OFFICE

Pursuant to Chapter 7, Title One, Book II. Local Government Code of 1991 (Republic
Act 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).

TERESITA CABALBAG
Member

SUBSCRIBED AND SWORN to (or affirmed) before me this 4TH day of April 2024.

KRISTIAN PAUL C. SUPNET

Punong Barangay
KP Form No. 6

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay

OFFICE OF THE LUPONG TAGAPAMAYAPA

(Date)

WITHDRWAL 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 withdraw.)

Punong Barangay/Lupon
Chairman

CONFORME (Signatures):
1. 7.
2. 8.
3. 9.
4. 10.
5. 11.
6.

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
Albay
Municipality of
Barangay

OFFICE OF THE LUPONG TAGAPAMAYAPA

Barangay Case No.

For:
Complainant
/s

-against-

Respondent/s

C O M P L A I N
T

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.

Made this day of , 20 .

(Complainant/s)

Received and filed this day of , 20 .

Punong Barangay/Lupon Chairman

KP Form NO. 8

Republic of the
Philippines
Province of
Albay
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
, 20 at o’clock in the morning/afternoon
for the hearing
of your complaint.

This day of _, 20 _.

Punong Barangay/Lupon
Chairman

Notified this day of , 20 _.

Complainant/
s
KP Form No. 9
Page 2

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay

OFFICER’S
RETURN
I served this summons upon respondent on the day of
, 20 , and upon on the day
respondent of
, 20 , 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 and

person,
or

2. handing to him/them said summons and

he/they refused to serve 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)
KP Form No. 9

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay

OFFICE OF THE LUPONG TAGAPAMAYAPA

Barangay Case No.

For:
Complainant
/s

- against -

Respondent/s

S U M M O N
S

TO:

Respondent
s

You are hereby summoned to appear before me in person, together with your
witnesses, on the
day of , 20 , 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 , 20

Punong Barangay /Lupon Chairman

KP Form No. 10

Republic of the
Philippines
DEPARTEMNT OF THE INTERIOR AND LOCAL
GOVERNMENT MUNICIPALITY OF
Barangay

NOTICE FOR CONSTITUTION OF PANGKAT

TO :

Complainant/s Respondents/s

You are hereby required before me on the day of , 20

at
o’clock in the morning/ afternoon for the constitution of 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 _.

Punong Barangay

Notified this day of _, 20 .

Complainant/s Respondent/s
KP Form No. 11

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay

OFFICE OF THE LUPONG TAGAPAMAYAPA

BARANGAY Case No.

For:
Complainant
/s

-
against-

Respondent/s

N O T I C E T O C H O S E N P A N
G K A TM E M B E R

(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

Received this day of , 20 .

Pangkat Member
KP Form No. 12

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay

OFFICE OF THE LUPONG TAGAPAMAYAPA

TO:

Complainant/s Respondent/s

NOTICE OF
HEARING
(CONCILIATION PROCEEDING)

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 , 20 .

Complaint/s Respondent/s
KP Form No. 13

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay

OFFICE OF THE LUPONG TAGAPAMAYAPA

Barangay Case No.

For:
Complainant
/s

-against-

Respondents

SUBPOEN
A

TO:

Witnesse
s

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

Chairman
(Cross out whichever one is not
applicable).
KP Form No. 14

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay
-o0o-

OFFICE OF THE LUPONG

TAGAPAMAYAPA

Barangay Case No.

For:
Complaint/
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 and voluntarily, after I had explained to them the nature and consequences of
such agreement.

Punong Barangay/Pangkat Chairman

KP Form No. 15

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay
-o0o-

OFFICE OF THE LUPONG

TAGAPAMAYAPA
=======================================================
=============
Barangay Case No.
For:
Compliant/
s

-against-

Respondent/s

ARBITRATION
AWARD

After hearing the testimonies, given the careful examination of the evidence
presented in this case, award is hereby made as follows:

Made this day of , 20 at .

Punong Barangay/Lupon 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 by the Pangkat Chairman, and
by the
Lupon Secretary if the award is made by the Punong Barangay.
KP Form No. 16

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay
-o0o-

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 , 20 .

Complaint/s Respondent

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
KP Form
17 Republic of the
Philippines
Province of
Albay
Municipality of
Barangay
-o0o-

OFFICE OF THE LUPONG TAGAPAMAYAPA

===================================================
======================
Barangay Case No.
For:
Complainant/s

- against –

Respondent/s

REPUDIATIO
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

SUBSCRIBE AND SWORN TO before me this day of _, 20

at
.

Punong Barangay/Pangkat
Chairman/Member

Received and filed this day of , 20 .

 Punong Barangay

* Failure to repudiate the settlement or the arbitration agreement within the time limits respectively set (ten (10)
days from date of settlement and five (5) days from the date or arbitration agreement shall deemed a waiver of the right to
challenge on said grounds.
KP Form No. 18

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay
-o0o-

OFFICE OF THE LUPONG

TAGAPAMAYAPA

Barangay Case No.

For:
Complaint/
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 , 20 and why your complaint
scheduled on 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 , 20 .
day of

Punong Barangay/Pangkat Chairman

Notified this day of

, 20 . Complainant/s
KP Form No.
19 Republic of the
Philippines
Province of
Albay
Municipality of
Barangay
-o0o-

OFFICE OF THE LUPONG

TAGAPAMAYAPA

=======================================================
===================
Barangay Case No.
For:
Complainant
/s

-against-

Respondent/s

NOTICE OF HEARING
(Re: FAILURE TO
APPEAR)

TO:

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

the
, 20 , at o’clock in the morning/afternoon
to explain why
you failed to appear for mediation/conciliation scheduled on and why
, 20 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 , 20 .

Punong Barangay/Pangkat Chairman

/’(Cross out whichever is not
applicable)

Notified this day of _, 20

. Respondent/s:

Complainant/s
(KP Form No. 20)

Republic of the Philippines

Province of Albay
City of
Barangay
-o0o-

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. An amicable settlement/ agreement to arbitrate was reached;

3. The settlement/agreement 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 , 20 .

Lupon Secretary

Attested:

Lupon Chairman
KP Form No. 20-A

Republic of the Philippines

Province of Albay
City of
Barangay
-o0o-

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 , 20 .

Pangkat Secretary

Attested by:

Pangkat Chairman
KP Form No. 20-B

Republic of the Philippines

Province of Albay
City of
Barangay
-o0o-

OFFICE OF THE LUPONG TAGAPAMAYAPA

Barangay Case No.

For :
Complainant
/s

-against-

Respondent/s

CERTIFICATION TO FILE ACTION

This is to certify that:

1. Parties were called for mediation of the complaint but the mediation
proceeding did not result to any amicable settlement;

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.

Issued this day of , 20 .

Pangkat Secretary

Attested by:

Pangkat Chairman
Revised KP Form No. 21

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay
-o0o-

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 _, 20 .

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.
KP Form No. 22

Republic of the
Philippines
Province of Albay Municipality of

Barangay
-o0o-

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/her counterclaim ( if any) arising from the
complaint in court/ government office.

This day of , 20_ _.

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.
KP Form No. 23

Republic of the
Philippines
Province of Albay Municipality of
Barangay
-o0o-

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 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 requests that the corresponding writ of

execution be issued by the Lupon Chairman in this case.

(Date) Complaint/s Respondent/s

KP Form No. 24

Republic of the
Philippines
Province of
Albay
Municipality of
Barangay
-o0o-

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

, 20 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/respondent/s).

(Date)

Punong Barangay/Lupon Chairman

Notified this day of , 20 _.

(Signature)
(Signature) Complainant/s
Complainant/s
KP Form No. 25
Republic of the Philippines
Province of Albay Municipality of
Barangay
-o0o-

OFFFICE OF THE LUPONG

TAGAPAMAYAPA

Barangay Case No.

For :
Complainant
/s

-against-

Respondent/s

NOTICE OF
EXECUTION

WHEREAS, on _, an amicable settlement was

signed by the parties in the above-entitled case (or an arbitration award rendered by the
Punong Barangay/Pangkat ng Tagapagkasundo):
WHEREAS, the terms and conditions of the settlement, the dispositive portion of the
read award,
:

The said settlement/award is now final and executory;

WHEREAS, the party obliged 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 upon me and the Lupon by the Katarungang Pambarangay Law and
Rule, I shall cause to be realized from the goods and personal property of
the sum of
(name of party obliged)
agreed
( state amount of settlement or award)
upon in the said amicable settlement ( or adjudged in the arbitration award)
unless voluntarily 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