CERTIFICATE TO FILE ACTION

Barangay ____________
Municipality/City of _________________
Province of ____________________

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.
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)