Scribd
Upload
7 views2 pages

Barangay Protection Order Template

The document is a Barangay Protection Order (BPO) issued in the Municipality of Mambajao, Camiguin, Philippines. It orders the respondent to cease any actions that may cause physical harm to the applicant and/or her children, effective for 15 days. Violation of this order is punishable by law, and it includes spaces for signatures and dates for receipt and service.

Uploaded by

baylao.brgy.council
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
7 views2 pages

Barangay Protection Order Template

The document is a Barangay Protection Order (BPO) issued in the Municipality of Mambajao, Camiguin, Philippines. It orders the respondent to cease any actions that may cause physical harm to the applicant and/or her children, effective for 15 days. Violation of this order is punishable by law, and it includes spaces for signatures and dates for receipt and service.

Uploaded by

baylao.brgy.council
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Republic of the Philippines

Province of Camiguin
Municipality of Mambajao
BARANGAY BAYLAO

OFFICE OF THE PUNONG BARANGAY

VAWC Form #4 CONTROL No. _____________

BARANGAY PROTECTION ORDER (BPO)

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 THIS ORDER IS PUNISHABLE BY LAW.

RUCHIE R. CHAN-BACOR
Punong Barangay

Date issued: _____________________

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)

You might also like