Republic of the Philippines Department of Justice NATIONAL PROSECUTION SERVICE OFFICE OF THE PROSECUTOR MANILA CITY
INVESTIGATION DATA FORM To be accomplished by the Office:
NPS DOCKET NO.:
DATE RECEIVED:
(Stamped and Initialed) ___________________ Time Received: ________________________ Receiving Staff: ________________________
XV-07-INV
.
Assigned to: __________________________ 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 _____________________________________
_RAMON G. TALAN___________________
RONALD C. PEREZ_____________________
_____________________________________
_____________________________________
____________________________________
_____________________________________
OFFENSE/s COMMITTED/ LAW/s VIOLATED:
WITNESS/es: Name& Address
_____________________________________
_JOSELITO P. VILLA- at No. 592 J.P.
Rizal __PERJURY under Art. 183______________
Street, Brgy.
Concepcion, Marikina City __of the Revised Penal Code_____________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
DATE & TIME OF COMMISSION:
PLACE OF COMMISSION:
______March 7, 2016___________________
____Quezon City______________________
_____________________________________
_____________________________________
1. Has a similar complaint been filed before any other office?* 2. Is this complaint in the nature of a counter- charge?* 3. Is this complaint related to another case before this office?* 4.
YES____ YES____ YES____
NO____ NO____ If yes, indicate details below NO____ if yes, indicate details below
I.S./NPS Docket No. __________________________ Handling Prosecutor:__________________________
C E R T I F I C A T I O N* I CERTIFY, under oath, that all the information in this sheet is true and correct to the best of my knowledge and belief, I have not commenced any action r filed any claim involving the same issues in any court, tribunal, quasi-judicial agency, and that if I should learn that a similar action has been filed and/or is pending, I shall report that fact to this Honorable Court within five (5) days from knowledge thereof. ________________________________________ (Signature over Printed Name) SUBSCRIBED AND SWORN TO before me this ____________ day of ____________, 20___, in _________________________________________.
istering Prosecutor/ Officer