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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
QUEZON 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 VIOLATED: WITNESS/es: Name & Address


QUALIFIED THEFT UNDER ART. 310 in relation To follow
to ART. 308 of the Revised Penal Code (several
counts)
DATE & TIME of COMMISION: PLACE of COMMISION:
Various dates in 2013-2014. Please see attached Quezon City
table.

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, u n d e r o a t h , t h a t a l l t h e i n f o r m a t i o n o n t h i s s h e e t a r e t r u e a n d c o r r e c t t o t h e b e s t o f m y
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)

SUBCRIBED AND SWORN TO before me this ____________ day of _________________ ,20 ________,
In ________________________________________.

_____________________________________
Administering Prosecutor / Office
*1, 2, 3, and CERTIFICATION need not to be accomplished for inquest cases