Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
__________________________
__________________________

________________________,
Complainant/s,
I.S. No. ___________________
-versus- For:______________________

________________________,
Respondent/s.
x-----------------------------------------x

REQUEST FOR PRELIMINARY INVESTIGATION

AND WAIVER OF ARTICLE 125, REVISED PENAL CODE
(Where Arrest was Properly Effected)

With the assistance of counsel of my choice, I wish to avail of my right to a preliminary

investigation, and for this purpose, I hereby voluntarily waive my rights under the provisions of
Article 125 of the Revised Penal Code. Pending the completion of the preliminary investigation
proceedings, I agree to remain under police custody.

_____________________, Philippines
(Place)
_____________________.
(Date)

_____________________
Respondent
(Signature over printed name)

Assisted By:

_____________________
Counsel
(Signature over printed name)