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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hereby withdrawn effective upon receipt hereof, on the following ground/s:
(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. _________________________
__________________
Signature