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Malaybalay Investigation Data Form

This document contains an investigation data form from the National Prosecution Service regarding a complaint filed against respondent John Doe. The complainant, a police officer, alleges that Doe violated RA 9287 (sale of e-cigarettes) on September 15, 2022 at 11:11AM in Sitio ___, Bukidnon. No similar complaints have been filed. The complainant certified under oath that the information provided is true and correct.

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100 views1 page

Malaybalay Investigation Data Form

This document contains an investigation data form from the National Prosecution Service regarding a complaint filed against respondent John Doe. The complainant, a police officer, alleges that Doe violated RA 9287 (sale of e-cigarettes) on September 15, 2022 at 11:11AM in Sitio ___, Bukidnon. No similar complaints have been filed. The complainant certified under oath that the information provided is true and correct.

Uploaded by

Kaikai
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

NATIONAL PROSECUTION SERVICE

OFFICE OF THE PROVINCIAL PROSECUTOR


City of Malaybalay
Province of Bukidnon
FOR EDUCATIONAL PURPOSES ONLY

INVESTIGATION DATA FORM

DATE RECEIVED:
(Stamped and initialed) ________________ NPS DOCKET NO: ______________________
Time received: _______________________ Assigned to: ___________________________
Receiving Staff: _____________________ Date Assigned: _________________________

To be accomplished by complainant/counsel/law enforcer


COMPLAINANT RESPONDENT/S
Name: PSMS ______________________ Name: ____________________ y __________
Sex: Male Sex: Male
Age: 39 Age: 48 years’ old
Address: Brgy _____________, Bukidnon Address: P-1 _____________,. Bukidnon
Birthday: November 04, 1982 Birthday: July 15, 1974
Birth Place: _____________ Birth Place: _____________, Misamis Oriental

OFFENSE COMMITTED LAW/S VIOLATED WITNESSES/ADDRESS

Viol. Of RA 9287
DATE & TIME OF COMMISSION: PLACE OF COMMISSION:

15 September 15, 2022/11:11AM P7 SITIO __________________________________, BUKIDNON


__ _____________________ ______________________________
1. Has a similar complaint been filed before any other office? YES_______ NO ___X___
2. Is this complaint in the nature of a counter-charge? YES _______ NO ___X___
If yes, indicate details below.
______________________________________________________________________________

3. Is this complaint related to another case before this office? YES _______ NO__X___
If yes, indicate details below.
______________________________________________________________________________
NPS. DOCKET NO. ________________________
HANDLING PROSECUTOR: ______________

CERTIFICATION

I CERTIFY, under oath, that all 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 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.

PSMS _____________________________
(Complainant, Signature over printed name)

SUBCRIBED AND SWORN TO before me this _______ day of September, 2022,


in_________________________________.

_________________________________
Prosecutor Administering Oath

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