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Investigation Data Form

This document is an investigation data form from the National Prosecution Service in the Philippines. It provides information about a complaint, including the complainant and respondent's names and addresses, the alleged offenses committed and laws violated, witnesses, date and place of the alleged incident. The complainant certifies that the information is true and correct, that they have not filed any similar claims in other courts, and will report if a similar action is filed. The form is signed and sworn by the complainant and certified by an administering prosecutor.

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Chelle Dedz
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159 views2 pages

Investigation Data Form

This document is an investigation data form from the National Prosecution Service in the Philippines. It provides information about a complaint, including the complainant and respondent's names and addresses, the alleged offenses committed and laws violated, witnesses, date and place of the alleged incident. The complainant certifies that the information is true and correct, that they have not filed any similar claims in other courts, and will report if a similar action is filed. The form is signed and sworn by the complainant and certified by an administering prosecutor.

Uploaded by

Chelle Dedz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, 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
OFFICE OF THE CITY PROSECUTOR
Hall of Justice,Surigao City

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 enforcer:


(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


_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
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 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.
__________________________________
(Signature over printed name)

SUBSCRIBED AND SWORN to before me this ____ day of September 2019 at Surigao 2019. I
HEREBY CERTIFY that I have personally examined the affiant and that I am satisfied that the affiant
voluntarily executed and understood his affidavit.

_____________________________________

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


NPS Investigation Form No. 01 s.2008

Administering Prosecutor / Office

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

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