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CERTIFICATE TO FILE ACTION Republic of the Philippines Province of ______________ Municipality of ______________ Barangay ___________ This is to certify that

complainant _____________________ and defendant ___________________ underwent barangay conciliation in this office. There were several meetings held to amicably settle the issue on _________________________, however, no agreement was reached by the parties except to elevate the matter to court. [If the defendant refuses to appear, use this instead: This is to certify that complainant _____________________ had requested this office to help him/her amicably settle with defendant ___________________. However, the defendant refused to appear for at least two scheduled meetings.] This certificate is issued on ______________________ upon the complainants request as a condition precedent for the filing of action in court. (Signature over printed name of Barangay Captain or Presiding Officer of Lupon)

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