Katarungang Pambarangay Form No.

7
Republic of the Philippines
Province of _______________
City / Municipality of _______
Barangay _________________
OFFICE OF THE LUPONG TAGAPAMAYAPA
__________________________
__________________________
Complainant/s

Barangay Case No. ____________________

For:

______________________________
______________________________
- against _________________________
_________________________
Respondent/s
COMPLAINT
I / WE hereby complain against the above named respondents 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 _____ .

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Punong Barangay / Lupon Chairman