Complaint Form — Barangay Bolbok

Republic of the Philippines · Province of Batangas

Barangay Bolbok

Batangas City, Batangas · Tel: 043 980 0831 · contact@bolbok.gov.ph

COMP-FORM-001

Rev. 01 · 2026

Complaint / Blotter Report Form

Control No.: Date Filed:

Complainant Information

Last Name

First Name

Middle Name

Contact Number

Age

Complete Address

Respondent / Subject of Complaint

Name of Respondent (if known)

Address of Respondent (if known)

Nature of Complaint

Noise / Disturbance

Domestic / Family Dispute

Property Dispute

Threat / Harassment

Physical Altercation

Illegal Activities

VAWC

Others (specify below)

Others / Specify Nature of Complaint

Details of Complaint

Date of Incident

Time of Incident

Place / Location of Incident

Narrative of Complaint (describe what happened)

Witness Name/s (if any)

I hereby attest that the information stated above is true and correct to the best of my knowledge. I understand that filing a false complaint is punishable under applicable laws.

Complainant's Signature over Printed Name

Date: __________________________

Received By — Barangay Official

Barangay Bolbok, Batangas City

For Office Use Only

Blotter No.

Date Recorded

Action Taken

* All complaints are handled with confidentiality. For urgent concerns, contact the Barangay Hall at 043 980 0831 or visit during office hours (Mon–Fri, 8:00 AM – 5:00 PM).