NPS Investigation Form No.

01, s. 2008
Republic of the Philippines
Department of Justice
National Prosecution Service
OFFICE OF THE CITY PROSECUTOR
Antipolo City
INVESTIGATION DATA FORM
To be accomplish by the office
DATE RECEIVED: ___________________________________ NPSDOCKET:
______________________________________________
(Stamped and initialed):
Time Receive: _______________________________________ Assigned
_______________________________________________
Received Staff:_______________________________________
Date
Assigned:_____________________________________________

to:

(To be accomplished by Complainant/Counsel/Law Enforcer)

(Use back portion if space is not sufficient)
COMPLAINANT/S: Name, Sex, Age & Address
RESPONDENTS/S: Name, Sex, &
Address
LINALYN RUBIO y AZUR Female, 34 JOSE ADOR y DULDULAO Male and
years of age and currently residing at currently
residing
at
Sito
Kamias,
1073 Sitio Sagipin, Barangay Dela Paz, Barangay Bagong Nayon, Antipolo City.
Antipolo City
LAWS/VIOLATED:
Reckless Imprudence Resulting to
Homicide

WITNESS/S: Name & address:

JOHN
REYNOLD
RUBIO
y
AZUR
currently residing at 1073 Sitio Sagipin,
Barangay Dela Paz, Antipolo City.
DATE & TIME of COMMISSION:
PLACE of COMMISSION:
At about 6:00 in the evening of October 1, NHA Avenue, Barangay San Luis, Antipolo
2015
City
1. Has similar complaint been filed before any other office? YES____ NO____
2. Is this complaint in the nature of counter-affidavit?
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 No.: ______________________________________
Handling Prosecutor:______________________
*CERTIFICATION*
I CERTIFY, under oath all the information on this sheet are true and correct to
the best my
knowledge and belief. That I have not commenced any action or filed
any claim involving the same issues in court, tribunal, or quasi-judicial agency, and if
I should thereafter learn that similar action has been filed and/or is pending, I shall
report that fact to his honorable office within five (5) days from knowledge thereof.
LINALYN RUBIO y AZUR
Signature over PRINTED Name
SUBSCRIBED AND SWORN TO before me this ____day of ____________, 2015 in the
Philippines.
__________________________________
Prosecutor
Oath

Administering

*1,2,3 and certification need be accomplished for Inquest Case*

Republic of the Philippines

National Police Commission
PHILIPPINE NATIONAL POLICE
ANTIPOLO CITY POLICE STATION
Traffic Section
Sitio Langhaya, Bgy Dela Paz, Antipolo City
( 393-8829
ACPS
October 5, 2015

TO:

Honorable City Prosecutors

Antipolo City, 2nd Floor Hall of Justice,
Bgy San Jose, Antipolo City

Dear Sir/Madam:
I have the honor to refer to your good office for appropriate action the record of
investigation relative the cases of Reckless Imprudence Resulting to Homicide
for your evaluation and proper disposition. (For Inquest)

I.Date/Time and Place of Incident: October 1, 2015 at about 6:00 in the evening along
NHA Avenue, Barangay San Luis, Antipolo City.
II. Complainant: LINALYN RUBIO y AZUR 34 years of age, born on October 1, 1981 at
Manila, single and currently residing at 1073 Sitio Sagipin, Barangay Dela Paz, Antipolo
City
III. Victim: CYRUS CASILOM y RUBIO 5 years of age, born on May 31, 2010 and
currently residing at 1073 Sitio Sagipin, Barangay Dela Paz, Antipolo City.
IV. Suspect: ADOR JOSE y DULDULAO of legal age, born on July 05, 1968, driver and
currently residing at Sitio Kamias, Barangay Bagong Nayon, Antipolo City.
V. Arresting Officers: PO2 RONNIE AGTARAP and PO2 JOEL QUINANAHAN both of
legal age, members of the Philippine National Police, assigned at Antipolo City Police
Station, Police Community Precinct 2 as Mobil Patrol Crew.
VI. Witnesses: JOHN REYNOLD RUBIO y AZUR 10 years of age and currently residing at
1073 Sitio Sagipin, Barangay Dela Paz, Antipolo City.

Facts of the Case

:
See Attached Documents

FOR OIC ACPS:

PSINSP RAMIL TIRONA

Chief IDMS

Enclosure:
Affidavit of Complaint, Investigation Report and Others

Republic of the Philippines

National Police Commission
PHILIPPINE NATIONAL POLICE
ANTIPOLO CITY POLICE STATION
Traffic Section
Sitio Langhaya, Bgy Dela Paz, Antipolo City
( 477-3519

ACPS/PCP2
MEMORANDUM
FOR

: OIC ACPS

FROM

: Officer-on-case

SUBJECT

: Investigation Report re Reckless Imprudence Resulting to

Homicide

DATE

: October 1, 2015

1. References: a.) Affidavit of Complainant

b.) Standard Operating Procedure (SOP)
2. That on October 1, 2015 at about 6:00 in the evening along NHA Avenue,
Barangay San Luis, Antipolo City., wherein the complainant was identified as., the victim
was identified as CYRUS CASILOM y RUBIO 5 years of age, born on May 31, 2010 and
currently residing at 1073 Sitio Sagipin, Barangay Dela Paz, Antipolo City., arresting
officers were identified as PO2 RONNIE AGTARAP and PO2 JOEL QUINANAHAN, the
witness was identified as JOHN REYNOLD RUBIO y AZUR 10 years of age and currently
residing at 1073 Sitio Sagipin, Barangay Dela Paz, Antipolo City. and the suspect was
identified as ADOR JOSE y DULDULAO of legal age, born on July 05, 1968, driver and
currently residing at Sitio Kamias, Barangay Bagong Nayon, Antipolo City.
2.
Investigation conducted disclosed that at the time place and date of incident
suspect onboard a passenger utility vehicle traversing along NHA Avenue, Barangay San

Luis, Antipolo City going to Padilla and coming from Cogeo Gate 2 and upon reaching the
place of incident the victim was run over by the victim, thereafter the victim was brought
to the nearest hospital for medical attention and was declared dead on arrival by the
attending physician.

4. For inquest.

PO3 ESQUIBIL REYNARD LEVIN

Investigator

Republika ng Pilipinas }
Lalawigan ng Rizal
} S.S.
Lungsod ng Antipolo
}
X============X
SINUMPAANG SALAYSAY NG REKLAMO
(Affidavit of Complaint)
Ako LINALYN RUBIO y AZUR 34 taong gulang, ipinanganak noong Oktubre 3,
1981 sa Manila, walang asawa at kasalukuyang nakatira sa 1073 Sitio Sagipin, Barangay
Dela Paz, Antipolo City., na matapos makapanumpa ng naaayon sa ating saligang batas
ay malaya at kusang loob na nagsasabi gaya ng mga sumusunod;
NA, nitong ika-6:00 ng gabi ng Oktubre 1 taong 2015, habang kasalukyang
nakasakay sa habang ako ay nagaalaga ng aking apat na anak, pumunta sa aming bahay
ang pamangkin ko na sina BUBOY at TOTOY at sinabi nila sa akin na nabangga ang
aking anak na si CYRUS RUBIO at ito daw po ay iniwan ng driver na nakabangga sa
kanya.
NA, agad akong nagpunta sa lugar na pinangyarihan at doon nakakita ako ng
naguumpukang tao at nakita ko na ang pinaguupukan nila ay ang aking anak na
nakahandusay sa kalsada, agad kong kinuha ang aking anak at sinakay ko ito sa Tricycle
at dinala ko ito sa pinakamalapit na ospital at doon ay sinabihan nila ako na wala ng
buhay ang aking anak na si CYRUS RUBIO.
BILANG PATUNAY sa lahat ng aking sinabi ay aking ilalagda ang aking buong
pangalan sa ibaba ng salaysay na ito na sa akin ay walang namilit, nanakot o
nagbigay/nangako ng anumang pabuya bagkus ito ay aking kusang loob. WAKAS NG
SALAYSAY.........BINASA, INUNAWA, BAGO NILAGDAAN.

LINALYN RUBIO y AZUR

Nagsalaysay
SUBSCRIBED AND SWORN to before me this ____ day of October 1, 2015 here at
Antipolo City and I hereby certify that I have personally examined the affiant and I am
satisfied that he/she voluntarily executed and understood this statement.

Administering Officer

MALAYA AT KUSANG LOOB NA SALAYSAY NI JOHN REYNOLD RUBIO NA IBINIGAY SA

PAGTATANONG SA GABAY NG KANYANG INA NA SI JOCELYN RUBIO y AZUR NI PO3
ESQUIBIL REYNARD LEVIN ESQUIBIL DITO SA TANGGAPAN NG PAGSISIYASAT NG
ANTIPOLO CITY POLICE STATION, POLICE COMMUNITY PRECINCT 2, BGY DELA PAZ,
ANTIPOLO CITY NGAYONG IKA-5 NG OKTUBRE 2015 SA GANAP NA IKA-1:30 NG UMAGA
SA HARAP NI PO3 FELOMENO SORIANO.
X===================================================
===============X
MGA TANONG AT SAGOT
01.
TANONG
: BB/Gng/Ginoo JOHN REYNOLD RUBIO, ikaw ba ay magsasabi ng
katotohanan at pawang katotohanan lamang sa pagsisiyasat na ito?
SAGOT
: Opo.
02.
TANONG
: Ano ang iyong buong pangalan, edad, araw ng kapanganakan, civil status,
hanapbuhay at kasalukuyang tirahan?
SAGOT
: JOHN REYNOLD RUBIO 10 taong gulang, ipinanganak noong at
kasalukuyang nakatira sa Sitio Sagipin, Barangay Dela Paz, Antipolo City
03.
TANONG
salaysay?
SAGOT

: Ikaw ba ay handang magbigay ng iyong malaya at kusang-loob na

: Opo.

04.

T
S

: Ano ginagawa niyo bago mangyari ang aksidente?

: Patawid

05.

: Sinong kasama mo tumawid?

04.

: si BUBOY at si CYRUS

T
S

: Saan kayo papunta?.

: Pa-uwi na.

05.

T
: Pagkatapos noon ay pumunta kami sa tindahan at nakiinom kami ng tubig
S
: Pinainom kami ng babae at tapos noon, ay nanghihingi si CYRUS ng tubig
kay BUBOY hindi niya ito bingyan kaya umiyak ito sa gilid ng kalsada.
04.

T
S

: Noong umiiyak si CYRUS sa gilid ng kalsada anong nangyari?

: Nabunggo po siya

10.

T
S

: Ano yung nakabunggo sa kanya?

: Jeep.

11.

T
S

: Ano parte ng jeep ang nakabangga kay CYRUS?

: Gilid

12.

T
S

: Saan papunta ang jeep?

: Padilla

13.

T
S

: Mabilis ba ang takbo ng jeep?

: Oo

14.

T
S

: Ng nabangga nito si CYRUS anong ginawa nung drayber?

: Wala po.

15.

T
S

: Pagkatapos noon anong ginawa niyo?

: Tumawid kami at tinawag namin ang nanay ni CYRUS.

Pahina 1

Pahina
2
Karugtong
na
Salaysay
ni
JOHN
RUBIO .............................................................................................

REYNOLD

16. T
: Kung gayon, handa mo bang ilagay ang pangalan mo dito sa taas ng
iyong pangalan na ito ay iyong mga sinabi na sa iyo ay walang nanakot, namilit o
nangako ng anumang mga bagay, bagkus, ito ay iyong kusang-loob?
S
: Opo.
WAKAS NG SALYSAY
JOHN REYNOLD RUBIO
AZUR
Nagsalaysay
Nagsalaysay

JOCELYN RUBIO y

CERTIFICATION
SUBSCRIBED AND SWORN to before me this __ day of _______ 2015 herein
Antipolo City, Philippines. I HEREBY CERTIFY that I have personally examined the herein
affiant and I am fully satisfied that he/she voluntarily executed and understood his/her
affidavit.

Administering Officer

Republika ng Pilipinas }
Lalawigan ng Rizal
} S.S.
Lungsod ng Antipolo
}
X============X
SINUMPAANG SALAYSAY NG PAG-ARESTO
(Affidavit of Arrest)

KAMI PO1 RONNIE AGTARAP at PO2 JOEL QUINANAHAN pawang mga nasa
hustong taong gulang, miyembro ng Pambansang Kawani ng Pulisya at nakatalaga sa
Antipolo City Police Station, Police Community Precinct 2 bilang mga mobil patrol crew
na matapos makapanumpa ng naaayon sa ating saligang batas ay malaya at kusang loob
na nagsasabi gaya ng mga sumusunod;
NA, nitong ika-6:00 ng gabi ng Oktubre 1 taong 2015, habang kami ay
kasalukuyang tumutupad sa aming tungkulin bilang mga pulis ay may lumapit sa aming
mga tao at nagsabi na mayroong naaksidenteng bata sa NHA Avenue, Barangay San Luis,
Antipolo City at ito daw diumano ay nasagasaan ng isang pampasaherong jeep.
NA, bilang tugon sa naturang sumbong ay agaran kaming nagpunta sa lugar upang
tiyakin ang naturang aksidente, pagkarating namin doon ay nakita namin ang isang
isang bata na nakilala namin bilang si CYRUS RUBIO na nasa kalsada at ito ay hawak ng
kanyang ina at isinakay ito sa tricycle upang dalhin sa ospital.
NA, agad namin inalam mula sa mga taong naroon kung sino ang nakasagasa kay
CYRUS RUBIO at doon itinuro nila sa amin kung sino ang taong nakasagasa kay CYRUS
RUBIO, na agad naming pinuntahan ang nasa unahang jeep na siyang tinuturong
nakasagasa ni CYRUS RUBIO at doon ay agad naming inaresto at sinabi ang kadahilanan
ng kanyang pagkakaaresto at kanyang mga karapatan na naayon sa saligang batas sa
lalaking nagmamaneho ng jeep na nakilala namin bilang si JOSE ADOR y DULDULAO.
NA, matapos noon ay dinala namin si JOSE ADOR y DULDULAO sa pinakamalapit
na ospital upang ipamedikal at tapos noon sa aming himpilan upang masampahan ng
kaukulang kaso si JOSE ADOR y DULDULAO.
BILANG PATUNAY sa lahat ng aking sinabi ay aking ilalagda ang aking buong
pangalan sa ibaba ng salaysay na ito na sa akin ay walang namilit, nanakot o
nagbigay/nangako ng anumang pabuya bagkus ito ay aking kusang loob. WAKAS NG
SALAYSAY.........BINASA, INUNAWA, BAGO NILAGDAAN.

PO1 RONNIE AGTARAP

Nagsalaysay
PO2 JOEL QUINANAHAN
Nagsalaysay

SUBSCRIBED AND SWORN to before me this ____ day of October 1, 2015 here at
Antipolo City and I hereby certify that I have personally examined the affiant and I am
satisfied that he/she voluntarily executed and understood this statement.

Administering Officer

Republic of the Philippines

National Police Commission
PHILIPPINE NATIONAL POLICE
ANTIPOLO CITY POLICE STATION
Traffic Section
Sitio Langhaya, Bgy Dela Paz, Antipolo City
( 477-3519