(OPP-03 Form No. o1 Republic of the Philippines [ Department of Justice OFFICE OF THE PROVINCIAL PROSECUTOR Provines of Cavite | INVESTIG, DATA FORM! DATE RECEIVED: NPS, DOCKET NO.: (stamped and initialed): Time Received: Resigned to: Received by Date Assigned : To be accomplished by Complainant/Counsel/ Law Enforcer (Use back portion if space is not sufficient) COMPLAINANTIS : Name, Sex Age & Address RESPONDENTIS: Name, Sex, Age & Address LAWIS VIOLATED: WITMESSE’S: Hhme & adress DATE & TIME OF COMMISSION PLACE OF COMMISSION “1. Has a similar complaint been fled before any offces? YES __NO 2. Is this complaint in the nature of counter-charge?_ YES____NO___ if yes, indicate detalls below 3. Is this complaint rolated to another case before this Office7¥ES___NO___if yes, indicate details below. NPS Docket No: Handling Prosecutor: CERTIFICATION \ | CERTIFY, under oath, that all the information on this sheet are trup and correct to the best of my knowledge and belief, that | have not commenced any action or filed any claim involving the same Issued in any court, tribunal, quasi-judicial agency, and that if | should thereafter learn that a similar action had been filed and/or is pending, | shall report that fact to this Honorable Office within (6) days from knowledge thereof. I (Signature over Printed Namey day of at Imus, Cavite. SUBSCRIBED AND SWORN to before me this (Prosecutor Administering Oath) *4,2,3 and Certification need not be accomplished for Inquest Cases.