Control No. __________ BARANGAY PROTECTION ORDER Name of Respondent: _________________________________________ Address:
BARANGAY LAW/KATARAUNGANG PABARANGAY KATARUNGANG PAMBARANGAY is a system of dispute resolution instituted in all baranga
Republic of the Philippines City of Naga Barangay of Tabuco APPLICATION FOR BARANGAY PROTECTION ORDER 1. Name of Appli
Flowchart on the Issuance and Enforcement Of Barangay Protection Order (BPO) (Per RA 9262) START Victim-Survivor/ Peti
VAWC Form #4 _____________
BARANGAY PROTECTION ORDER NAME OF RESPONDENT: ___________________________________________ ADDRESS: _______________________________________________________
ORDER ____________________________________________ applied for a BPO on ______________________, under oath stating that: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ After having heard the application and the witnesses and evidence, the undersigned hereby issues this BPO ordering you to immediately cease and desist from causing or threatening to cause physical harm to ____________________________________________ and/or her child/children namely: ________________________________________ _______________________________________ ________________________________________ _______________________________________ ________________________________________ _______________________________________ This BPO is effective for 15 days from receipt.
VIOLATION OF PUNISHABLE BY LAW.
________________________________ Punong Barangay (Signature over printed name) Date
_____________________ Copy received by: ____________________________ (Signature over printed name) Date received: _______________________________ Served by: __________________________________
ATTESTATION (In case the Punong Barangay is not available) hereby attest that Punong Barangay ________________________________________ was unavailable to act on _________________________ at ____________ a.m./p.m. and issue such order. (date) (time) ________________________________ Barangay Kagawad (Signature over printed name)
