(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.