Republika ng Pilipinas

LALAWIGAN NG RIZAL

Road A Phase IV COGEO Village, Barangay Bagong Nayon, Antipolo City 1870 Rizal, Philippines
 barangay_bagongnayon@yahoo.com   647-0942   942-0358   bagongnayon.antipolo@gmail.com
www.facebook.com/BagongNayonOfficialPage   www.antipolo.ph

KP PORMULARYO BLG. 6

_____________, 20 ____

WITHDRAWAL OF APPOINTMENT

TO: _______________

After due hearing and with the concurrence of a majority of all the Lupong
Tagapamayapa members of this Barangay, your appointment as member thereof is
hereby withdrawn effective upon receipt hereof, on the following ground/s:

[] Incapacity to discharge the duties of your office as shown by ____________

_____________________________________________________________.

[] Unsuitability by reason of _______________________________________.

(Check whichever is applicable and detail or specify the act/s or omission/s constituting the
ground/s for withdrawal.)

LARRY T. ONZA
Punong Barangay/Lupon Chairman

CONFORME (Signatures):

1. _________________________ 7. _________________________
2. _________________________ 8. _________________________
3. _________________________ 9. _________________________
4. _________________________ 10. _________________________
5. _________________________ 11. _________________________
6. _________________________

Received this __________ day of _____________, 20____.

__________________
Signature

Barangay Bagong Nayon: Kabalikat sa Kaunlaran at Pagbabago ng Lungsod ng Antipolo.