NPS Investigation Form No. 01 s.

2008

Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
OF _______________
Hall of Justice, ___________

INVESTIGATION DATA FORM

To be accomplished by Office:

DATE RECEIVED: NPS DOCKET NO.:

(stamped and initialed): ___________________ ____________________________________
Time Received: _________________________ Assigned to: __________________________
Receiving Staff: _________________________ Date Assigned: _______________________

To be accomplished by complainant/counsel/law enforce:

(Use back portion if space is not sufficient)

COMPLAINANT/s: Name, Sex, Age & Address RESPONDENT/s: Name, Sex, Age, & Address
_________________________ ____________________________________
__________________________ ______ __________________________ _________ ___
_________________________________ _________________________________________
______________________________________ _______________________________
_______________________________ _____ _____________ _________________________

OFFENSE/s COMMITED / LAW/s VIOLATION: WITNESS/es: Name & Address

__________________________ _ ___________________ _____________
___ defined and penalized under Art. par. , ___ __________________________________
_in relation to Art. __ par. 2 ___________________________________
of The Revised Penal Code ___________________________________

DATE & TIME of COMMISION: PLACE of COMMISION:

____________
_______________________________________ _______________________________________

1. Has a similar complaint been filed before any other office? * YES ___ NO ___
2. Is this complaint in the nature of a counter-charge? * 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. / NPS Docket No.: _______________________
Handing Prosecutor: ________________________

C E R T I F I C A T I O N*
I CERTIFY, under oath, 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 this Honorable Office within five (5) days from knowledge
thereof.

______________________ ____
(Signature over printed name)

SUBCRIBED AND SWORN TO before me this ____________ day of ___________________ ,20 _______ ,
In ___________________________________________.

_____________________________________
Administering Prosecutor / Office

*1, 2, 3, and CERTIFICATION need not to be accomplished for inquest cases