Republic of the Philippines

NATIONAL POLICE COMMISSION

PHILIPPINE NATIONAL POLICE

COMPLAINT SHEET

-
(Complainant)

(Respondent)

Summary of Complaint:

I HEREBY CERTIFY that the details of the complaint are true and correct. That I
am aware that any false or misrepresentation of the facts may be used as evidence
against me before any court in the Philippines.

IN WITNESS HEREOF, I have hereunto affixed my signature this _____ day of

________,____, Philippines.

Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of April 2019 at

________, Philippines.

Administering Officer
 Republic of the Philippines
NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE

CERTIFICATE OF NON-FORUM SHOPPING

I, ________________, of legal age, presently assigned

______________________________________________________________________
____________________________________ after having been duly sworn to and in
accordance with law do hereby certify:

1. That I am the nominal complainant in _______________;

2. That I have not filed or commenced any complaint involving the same cause
of action in any other Disciplinary Authority, IAS or Office of the Ombudsman;

3. That to the best of my knowledge, no such complaint is pending before any

other Disciplinary Authority, IAS or Office of the Ombudsman;

4. That if there any such complaint which is either pending or may have been
terminated, I must state the status thereof; and

5. That if I learn that a similar action or proceeding has been filed or is pending
before any other police disciplinary authority, IAS or Office of the
Ombudsman; I must report such fact within five (5) days from knowledge
thereof.

Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of April 2019 at

_____________________, Philippines.

Administering Officer