Unit/Office:

QPPO/

NATIONAL HEADQUARTERS PHILIPPINE NATIONAL POLICE DIRECTORATE FOR LOGISTICS . NHQ Bldg, Camp Crame, Quezon City
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Stencil No.: _____________

STENCIL AND BALLISTICS CERTIFICATE

Instruction: One (1) form is good for one (1) firearm only. This certificate is to be prepared in three (3) copies. Print or type entries legibly. .

DESCRIPTION OF FIREARM
Kind/Type of FA (Pistol/Revolver/Shotgun/Rifle) Caliber:

Pistol
Make and Model: BERETTA Serial Number:

9mm M28859Z

STENCIL OF FIREARM
Serial Number Make and Model Other Markings

OTHER DETAILS
SOURCE OF FIREARM (SUPPLY/LOANED/DONATED) DATE (FROM (OFFICE/PERSON)

ORGANIC (If supplied provide Supply Directive No.)

(If Loaned/Donated MOA Details)

QPPO/PADRE BURGOS MPS PO2 Danilo B Rugayan Jr

Other Remarks: STENCIL TAKEN BY: (Signature over Printed Name) CERTIFIED CORRECT BY: (Signature over Printed Name)

(Designation/Position) (Date) For LSS Use: Property No.: _____________ Acknowledged by: __________________________ (Signature over Printed Name) For DL Use: Supply Directive No.: Acknowledged by: __________________________ (Signature over Printed Name)

(Designation/Position) (Date) File No.: ___________________ ______________________________ (Designation/Position) ___________ (Date)

File No.: ____________________ ______________________________ (Designation/Position) ___________ (Date)