Investigation Data Form- Manila 3s1k4t

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