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Investigative Data Form

This document is an investigation data form from the National Prosecution Service of the Philippines Department of Justice. It provides information about a complaint filed on October 21 or 22, 2018 regarding an offense that occurred at Lot 2669, Barangay Sabatan, Orion, Bataan. The form collects the names and addresses of the complainant, respondent, and witnesses. It also documents the laws violated and certifies that the information provided is true and correct.

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Daniel Valdez
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195 views1 page

Investigative Data Form

This document is an investigation data form from the National Prosecution Service of the Philippines Department of Justice. It provides information about a complaint filed on October 21 or 22, 2018 regarding an offense that occurred at Lot 2669, Barangay Sabatan, Orion, Bataan. The form collects the names and addresses of the complainant, respondent, and witnesses. It also documents the laws violated and certifies that the information provided is true and correct.

Uploaded by

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

NPS Investigation Form No. 01 S.

2008

REPUBLIC OF THE PHILIPPINES


DEPARTMENT OF JUSTICE
NATIONAL PROSECUTION SERVICE
OFFICE OF THE

INVESTIGATION DATA FORM


To be accomplished by the Office

DATE RECEIVED: NPS DOCKET NO.:

(stamped and initialed): ___________________________ XV-07 INV. ______________________


Time Received : ___________________________ Assigned to: _____________________
Receiving Staff : ___________________________ Date Assigned: ____________________

To be accomplished by the complainant / counsel / law enforcer:


(Use back portion if space is not sufficient)

COMPLAINANT/s: Name, Sex, Age & Address RESPONDENT/s: Name, Sex, Age & Address

OFFENSE/s COMMITTED ; LAW/s VIOLATED WITNESS/es: Name & Address

DATE & TIME OF COMMISSION: PLACE OF COMMISSION:

21 October 2018 in the evening or 22 October in the Lot 2669, Barangay Sabatan, Orion, Bataan
morning

1. Has a similar complaint been filed before any other office? YES _____ NO __√__
2. Is this complaint in the nature of a counter-charge? YES _____ NO __√__ If yes, indicate details below
3. Is this complaint related to another case before this office? YES _____ NO __√__ If yes, indicate details below

I.S./NPS Docket No. _________________________


Handling Prosecutor _________________________

C E R T I F I C A T I O N1
I CERTIFY, under oath, that all the information on this sheet are true and correct to the best of my knowledge and belief, that
I have not commenced any action or filed any claim involving the same issues in any court, tribunal, or quasi-judicial agency, and that
if I should thereafter learn that a similar action has been filed and/or is pending I shall report that fact to this Honorable Office within
five (5) days from knowledge thereof.

(Signature over printed name)

SUBSCRIBED AND SWORN TO before me this _______ day of __________, 20 ____


in ______________________________.

________________________________
Administering Officer

1
1, 2, 3 and CERTIFICATION need not be accomplished for inquest cases

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