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NPS Investigation Form No. 01 s. 2008
Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
lloilo City Prosecution Office
Hall of Justice, lloilo
INVESTIGATION DATA FORM
To be accomplished by the Office:
DATE RECEIVED: NPS DOCKET NO.:
{stamped and initialed):,
Time Received: Assigned to:
Receiving Staff: Date Assigned:
To be accomplished by complainant/counsel/law enforcer:
(Use back portion if space is not sufficient)
COMPLAINANTIS: Name, Sex, Age & Address RESPONDENTIS: Name, Sex, Age & Address
OFFENSE/S COMMITTED: WITNESS/ES: Name & Address
DATE & TIME of COMMISSION: PLACE of COMMISSION:
1, Has a similar complaint been filed before any other office?* YES__ NO__
2s this complaint inthe nature ofa counter-charge?* YES __ NO Hyes. i
3, | this complaint related to another case before this office?* — NO__ It yes, indi
NPS Docket No,
Handling Pros
CERTIFICATION
| CERTIFY, under cath, that ail the information on this sheet are rue and corre
not commenced any action or fled any claim involving the same issues in any court, trounal, or quasi-judicial
thereafter learn that a similar action has been filed andior is pending, | shall repor that fet to this Honorable
knowledge thereo!
SUBSCRISED AND SWORN TO before me this day of _
‘Aaministenng P
2,3 and CERTIFICATION need not be accomplished for inquest cases NPS Invest
ion Fon No.0 s, 2008
Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
Hoilo Provincial Prosecution Office
Hall of Justice, lloilo
INVESTIGATION DATA FORM
To be accomplished by the Ofice:
DATE RECIVED: NPS DOCKET NO.:
(stampod and initiate)
Time Received: Assigned to:
Receiving Staff Date Assigned:
To be accomplished by complaiant/counsel/law enforcer:
(Use back portion if space is not sufficient)
COMPLAINANTIS: Name, Sex, Age & Address RESPONDENT/S: Nam
x, Age & Address
OFFENSE/S COMMITTED: WITNESSIES: Name & Address
DATE & TIME of COMMISSION: PLACE of COMMISSION’
‘Tilaca nator omnplait born Rod Pere wy ober of
21s ths complaint in the ature of w counter ahasge?®
3 sth complaan related to another eave before this fce?*
se imfiate deta below
yes beaten
NPS Docket No,
Handling Prosccuioe
CERTIFICATION®
CERTIFY, under oth, tht lf the inkrmation on this shet ae tue and ests othe best of my know
ot commenced any action er filed any sain involving the sams sus i any et, tna, of pun judul veorcy wat
‘Bercafer lem th
Boos legode trot
AT shoud
‘miu action has been ied andor is pening. I sal epee he fatto this Haneable Ofhicewahin Gee vo) Las a
SUBCRIBED AND SWORN TO before me this
Rag roses Once
