Republic of the Philippines

National Police Commission

PHILIPPINE NATIONAL POLICE
Police Station 9
Purok 3, Irisan, Baguio City
1
CHAIN OF CUSTODY FORM
9
I.
Turnover by: ________________________
0
Received by: _____________________
(Signature over printed name) (Signature over printed name)

Date and Time of Turnover/Received: _______________________

II.
Nature of the Case: Violation of PD 1866 as amended by RA 9516, for unlawful sale and
possession of Explosives and incendiary devices.
Date, Time, Place of Occurrence: April 20, 2018; 3:00PM; Purok 20, Idogan Village, San
Carlos Heights, Baguio City at the basketball court.
Name of Suspect/s: JAIME SUWAGEN KELLY and JOEL PABLO PAGTILAN
Name of Complainant/s: PCI PABLO EMMANUEL NEAD et al.

III.

DESCRIPTION OF EVIDENCE RECEIVED

QUANTITY DESCRIPTION REMARKS
Dynamite fuse (color red) and marked with the
initial of poseur buyer SP01 Drexel Pangisban From the custody of SP01
300 ft DDP1 20-4-2018 and seizing officer P02 Vengua Pangisban to the custody of P02
DDV1 20-4-2018 with their affixed signature Vengua
Nitro Emulsion Explosive Dynamite wrapped in
color yellow cellophane and was marked with
75 pcs masking tape by SP01 Pangisban with his initial
and signature to read as DDP2 20-4-2018 up to
DDP76 20-4-2018 together with the initial and
signature of P02 Vengua to read as DDV2 20-4-
2018 up to DDV76 20-4-2018
75 pcs Nitro Emulsion Explosive Dynamite wrapped in
color yellow cellophane and was marked with
masking tape by P02 Vengua to read as DDV77
20-4-2018 up to DDV155 20-4-2018 with affixed Custody of P02 Vengua
signature of the latter.
5 pcs 1000 peso bill used as buy bust money with the
following serial number

(NOTE: Please check the appropriate box if the evidence received was transferred to other person other than the
Custodian or examiner.)
YES NO
If yes, ___________________________ Date and Time Transferred ___________________
/ (Signature over printed name of recipient)

V.
Signature over printed name of Receiving Custodian: ____________________________
Date and Time of Receive: _________________________________________________

PURPOSE OF TURNOVER: For evidentiary purposes.