NPS Investigation Form No.

01 s 2008

Republic of the Philippines

Department of Justice
National Prosecution Service
Office of the City Prosecutor
Makati City

INVESTIGATION DATA FORM

To be accomplished by the Office:

DATA RECEIVED: NPS DOCKET NO..: XV-05-INV-

(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

TEODORICO C. SITCHON JOSE Y. BALUYUT

________________________________________ _______________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________

Contact Number

OFFENSE/s COMMITTED/LAW/s VIOLATED: WITNESS/es: Name & Address

GRAVE THREAT SALVADOR D. GRAMA
________________________________________ _______________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________

DATE & TIME of COMMISSION: PLACE of COMMISSION:

OCTOBER 19, 2019 MAKATI CITY
_______________________________________ _______________________________________
1. Has a similar complaint been filed any other Office? YES____ NO X
2. Is this Complaint in the nature of a counter-charge? YES ___ NO X
3. In this complaint related to another case before this Office? YES ___ NO X
I.S./NPS Docket No. __________________
Handling Prosecutor: _________________

CERTIFICATION

I CERTIFY, under oath, that all Information on this sheet are true and correct to the best of our 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 knowledge thereof.

TEODORICO C. SITCHON
(Signature over Printed Name)

SUBSCRIBED AND SWORN TO before me this ____ day of _____________ in Makati City,

________________________________
Administering Prosecutor/Office

1,2,3 and CERTIFICATION need not be accomplished for Inquest cases

NPS Investigation Form No.01 s 2008

 NPS Investigation Form No.01 s 2008

Republic of the Philippines

Department of Justice
OFFICE OF THE CITY PROSECUTOR
MAKATI CITY

INVESTIGATION DATA FORM

To be accomplished by the Office:

DATA 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

________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________

Contact Number

OFFENSE/s COMMITTED/LAW/s VIOLATED: WITNESS/es: Name & Address

________________________________________ _______________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________

DATE & TIME of COMMISSION: PLACE of COMMISSION:

_______________________________________ _______________________________________
_______________________________________ _______________________________________
1. Has a similar complaint been filed any other Office? YES____ NO __
2. Is this Complaint in the nature of a counter-charge? YES ___ NO ___
3. In this complaint related to another case before this Office? YES ___ NO___
I.S./NPS Docket No. __________________
Handling Prosecutor: _________________

CERTIFICATION

I CERTIFY, under oath, that all Information on this sheet are true and correct to the best of our 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 knowledge thereof.

____________________________
(Signature over Printed Name)

SUBSCRIBED AND SWORN TO before me this ____ day of _____________ in Makati City,

________________________________
Administering Prosecutor/Office

1,2,3 and CERTIFICATION need not be accomplished for Inquest cases

 NPS Investigation Form No.01 s 2008

Republic of the Philippines

Department of Justice
OFFICE OF THE CITY PROSECUTOR
CITY OF MANILA

INVESTIGATION DATA FORM

To be accomplished by the Office:

DATA 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

COMPLAINANT/s Name, Sex, Age & Address RESPONDENT/s: Name, Sex, Age & Address
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________

OFFENSE/s COMMITTED/LAW/s VIOLATED: WITNESS/es: Name & Address

PERJURY (ART. 183 OF RPC)

DATE & TIME of COMMISSION: PLACE of COMMISSION:

JUNE 11, 2018 MANILA

4. Has a similar complaint been filed any other Office? YES X NO __

5. Is this Complaint in the nature of a counter-charge? YES ___ NO X
6. In this complaint related to another case before this Office? YES ___ NO X
I.S./NPS Docket No. __________________
Handling Prosecutor: _________________

CERTIFICATION
I CERTIFY, under oath, that all Information on this sheet are true and correct to the best of our 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 except for Perjury case filed at Office of the City Prosecutor in Pasay City, 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 knowledge thereof.

APOLINARIO SAN MIGUEL DE ARMAS

(Signature over Printed Name)

SUBSCRIBED AND SWORN TO before me this ____ day of _____________ in City of Manila.

________________________________

Administering Prosecutor/Office

1,2,3 and CERTIFICATION need not be accomplished for Inquest files

NPS Investigation Form No.01 s 2008

Republic of the Philippines

DEPARTMENT OF JUSTICE
OFFICE OF THE CITY PROSECUTOR
VALENZUELA CITY
INVESTIGATION DATA FORM
To be accomplished by the Office:

DATA 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

FATIMA EVALIZA B. TALAG, of legal age_ ROQUE H. AREVALO, CARINA C. AREVALO

6020 Blk. 2 Unit 201 413 Marindal St.______ RIO MARIE G. AREVALO, all of legal age,____
Builders Ville Residences, Rincon,_______ 850 San Jose St., Daniel Fajardo,__________
Valenzuela City_______________________ Las Piňas City_________________________
____________________________________ ________________________________________
________________________________________ ________________________________________
________________________________________ ________________________________________
________________________________________ ________________________________________
Contact Number

OFFENSE/s COMMITTED/LAW/s VIOLATED: WITNESS/es: Name & Address

_ ESTAFA under Art. 315 (2-d)____________ ___________________________________
and VIOLATION OF B.P. 22_____________ ___________________________________
________________________________________ ________________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________
________________________________________ _______________________________________

DATE & TIME of COMMISSION: PLACE of COMMISSION:

_FEBRUARY 6, 2018_____________________ VALENZUELA CITY__________________

_______________________________________ _______________________________________
1. Has a similar complaint been filed any other Office? YES____ NO X
2. Is this Complaint in the nature of a counter-charge? YES ___ NO X
3. In this complaint related to another case before this Office? YES ___ NO X
I.S./NPS Docket No. __________________
Handling Prosecutor: _________________

CERTIFICATION

I CERTIFY, under oath, that all Information on this sheet are true and correct to the best of my 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 knowledge thereof.

____________________________
(Signature over Printed Name)

SUBSCRIBED AND SWORN TO before me this ____ day of _____________ in Valenzuela City.

________________________________
Administering Prosecutor/Office
1,2,3 and CERTIFICATION need not be accomplished for Inquest cases