Republic of the Philippines

Province of Cagayan
City of Tuguegarao

COMPLAINT SHEET
DATE RECEIVED:

NAME OF COMPLAINANT/S:
AGE:
NATIONALITY:
ADDRESS:

NAME OF RESPONDENT:
AGE:
ADDRESS:
BODY NUMBER:
COLOR:
ROUTE:

TRAFFIC VIOLATION/S:

CERTIFICATION

I CERTIFY, under oath, that all the information on this sheet are true
and correct to the best of my knowledge and belief.

__________________________
(Signature over printed name)
 I, ______________________________, of legal age and a
resident of _____________________________. I am filing this
complaint to formally charge _______________________,
driver/owner of a tricycle unit with body number ______________, for
refusing to convey passenger/for charging excessive fare