Republic of the Philippines

Department of the Interior and Local Government

in partnership with
National Police Commission

ADD CASE FORM

Complainant Information
Last Name
First Name
Middle Name
Suffix
Sex ☐Male ☐Female
Age
Civil Status ☐Single ☐Married ☐Annulled ☐Separated ☐Widowed
Occupation
Region
Province
City/Municipality
Barangay
Other Address
Contact Number

Respondent Information
Rank
Last Name
First Name
Middle Name
Suffix
Badge Number
Sex ☐Male ☐Female
Region
Province
City/Municipality
Barangay
Other Address
Station/Place of
Assignment
Contact Number
Complaint Information
☐Walk-in ☐Social Media ☐Email ☐Written ☐Phone Call ☐Text Message
Source of Complaint
☐Others
Place of Incident
Date of Incident
Time of Incident
Brief Narration of Facts
Jurisdiction ☐With Jurisdiction ☐Without Jurisdiction
Docket Number (w/
Jurisdiction)
Date and Time Docketed
(w/ Jurisdiction)
☐Neglect of Duty ☐Irregularity in the Performance of Duty ☐Misconduct
Nature of Offense (w/ ☐Dishonesty ☐Conduct Unbecoming of a Police Officer ☐Incompetence
Jurisdiction)
☐Oppression ☐Disloyalty to the Government
Type of Offense (w/ ☐Grave ☐Less Grave
Jurisdiction)
Remarks (w/ Jurisdiction)
Referred to (w/o
Jurisdiction)