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National Prosecution Service City Prosecution Office: Investigation Data Form

The document is an investigation form from the National Prosecution Service of the Philippines regarding a complaint filed by Imee D. Cam against the City Mall of Koronadal. It collects information about the complainant, respondent, laws violated, witnesses, date/time/location of the incident. The complainant certifies that the information is true and correct and that no similar case has been filed in other courts.

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Danielle Edenor Roque Padura
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117 views2 pages

National Prosecution Service City Prosecution Office: Investigation Data Form

The document is an investigation form from the National Prosecution Service of the Philippines regarding a complaint filed by Imee D. Cam against the City Mall of Koronadal. It collects information about the complainant, respondent, laws violated, witnesses, date/time/location of the incident. The complainant certifies that the information is true and correct and that no similar case has been filed in other courts.

Uploaded by

Danielle Edenor Roque Padura
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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NPS Investigation Form no. 01, s.

2008
Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
CITY PROSECUTION OFFICE
City of Koronadal

INVESTIGATION DATA FORM


To be accomplished by the Office

DATE RECEIVED: NPS DOCKET NO.:


(stamped and initialed):______________________ _____________________________________________
Time Received: ______________________________ Assigned to:__________________________________
Receiving Staff: _____________________________ Date assigned: ________________________________

To be accomplished by complainant/ counsel/ law enforcer


(Use back portion if space is not sufficient)

COMPLAINANT/s: Name, Sex, Age & Address RESPONDENT/s: Name, Sex, Age &
Address

IMEE D. CAM CITY MALL OF KORONADAL


Gensan Drive, Brgy. Zone IV,
City of Koronadal
__________________________________________
___________________________________________
__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
__________________________________________ __________________________________________
__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
__________________________________________
___________________________________________
__________________________________________ ___________________________________________

LAW/S VIOLATED: WITNESS/ES: Name &Address

__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
__________________________________________
___________________________________________
__________________________________________ ___________________________________________

DATE & TIME of COMMISION: PLACE of COMMISSION:

__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
NPS Investigation Form no. 01, s. 2008
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

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 quasi- judicial 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.

________________________________

SUBSCRIBED AND SWORN TO before me this _________________, in General Santos City,


Philippines.

_____________________________
Prosecutor Administering
Oath

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