NPS Investigation Form No. 01 s.

2008 Republic of the Philippines Department of Justice NATIONAL PROSECUTION SERVICE PROVINCIAL PROSECUTION OFFICE Pagadian City

INVESTIGATION DATA FORM

To be accomplished by the Office:

DATE RECEIVED:
(stamped and initialed): Time Received: Receiving Staff:

NPS DOCKET NO.:

Assigned to: date Assigned:

To be accomplished by complainant/counsel/law enforcer (Use back portion if space is not sufficient)

COMPLAINANT/s: Name, Sex, Age and Address 1. Dominador S. Claver, Male, yrs. Old, Purok Banaba, Brgy. Lenienza, Pag. City.

RESPONDENT/s: Name, Sex, Age & Address 1. Jeffrey Balat y Saavedra, Male, 21 yrs. Old, Purok Banaba, Brgy. Lenienza, Pag. City. 2. Japhet Balat y Magpayo, Male, 24 yrs Old, Purok Mangga, Brgy. Lenienza, Pag. City. 3. Rolly Balat y Tapal, Male, 27 yrs. Old, Purok Mangga, Brgy. Lenienza, Pag. City. WITNESS/es: Name & Address 1. Vilma Loquez y Claver, Purok Banaba, Baranay Lenienza, Pagadian City 2. Teofelo Loquez y Mendoza, Purok Banaba, Barangay Lenienza, Pagadian City 3. Willito Taya, Purok Banaba, Barangay Lenienza, Pagadian City 4. Lorito Javier y Esaga, Purok Banaba, Barangay Lenienza, Pagadian City 5. Angelito Taglap y Magalasin, Purok Banaba, Barangay Lenienza, Pagadian City

OFFENSES/s COMMITTED / LAW/s VIOLATED: FRUSTRATED MURDER

DATE & TIME of COMMISSION: January 16, 2012

1. Has a similar complaint been filed before any other office?* 2. Is this complaint in the nature of a counter-charge?* 3. Is this complaint related to another case before this office?*

PLACE of COMMISSION: Pagadian City

YES_____ NO__/__ YES_____ NO__/__ If yes, indicate details below 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 N*
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 quasijudicial 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 the Honorable Office within five (5) days from knowledge thereof.

Dominador S. Claver (Signature over printed name) SUBSCRIBED AND SWORN to before me on this _____th day of _______________, 20____, Pagadian City. Administering Prosecutor / Officer
*1,2,3 and CERTIFICATION need not be accomplished for inquiries cases

NPS Investigation Form No. 01 s. 2008 Republic of the Philippines Department of Justice NATIONAL PROSECUTION SERVICE PROVINCIAL PROSECUTION OFFICE Pagadian City

INVESTIGATION DATA FORM

To be accomplished by the Office:

DATE RECEIVED:
(stamped and initialed): Time Received: Receiving Staff:

NPS DOCKET NO.:

Assigned to: date Assigned:

To be accomplished by complainant/counsel/law enforcer (Use back portion if space is not sufficient)

COMPLAINANT/s: Name, Sex, Age and Address 1. Abusama B. Maguindra, Male, yrs. old, Brgy. Tuburan, Pagadian City. OFFENSES/s COMMITTED / LAW/s VIOLATED: FALSIFICATION BY PRIVATE INDIVIDUALS AND USE OF FALSIFIED DOCUMENTS. DATE & TIME of COMMISSION: December 11, 2012
1. Has a similar complaint been filed before any other office?* 2. Is this complaint in the nature of a counter-charge?* 3. Is this complaint related to another case before this office?*

RESPONDENT/s: Name, Sex, Age & Address 1. Mohaimen Pagayao Kundal, yrs. Old, Male, Lower Sang-an, Labangan, ZDS. WITNESS/es: Name & Address 1. Charito R. Jumuad, LCR Labangan, ZDS.

PLACE of COMMISSION: Pagadian City

YES_____ NO__/__ YES_____ NO__/__ If yes, indicate details below YES_____ NO__/__ If yes, indicate details below: I.S. / NPS Docket No.: Handling Prosecutor:

CERTIFICATION
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 quasijudicial 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 the Honorable Office within five (5) days from knowledge thereof. ABUSAMA B. MAGUINDRA (Signature over printed name) SUBSCRIBED AND SWORN to before me on this _____th day of _______________, 20____, Pagadian City. Administering Prosecutor / Officer
*1,2,3 and CERTIFICATION need not be accomplished for inquiries cases