Republic of the Philippines

PHILIPPINE NATIONAL POLICE

EASTERN POLICE DISTRICT OFFICE, NCRPO
MANDALUYONG CITY POLICE STATION
Sub-Station 9 (Bagong Silang)
A. Luna cor J. Luna Extension, Bagong Silang, Mandaluyong City

PNP ARREST AND BOOKING SHEET

(to be accomplished by the Arresting Officer)
Picture
2x2 BLOTTER ENTRY NR: DATE:
FRONT VIEW

(Last Name) (First Name) (Middle Name)

ADDRESS:
TEL NO. POB : DOB :
MARITAL STATUS: / SINGLE WIDOW/E SEX: MALE
MARRIED / SEPARATED / FEMALE
AGE________ WEIGHT: _________ HEIGHT: _________ EYES: __________________ HAIR:______________
COMPLEXION: ________________ OCCUPATION: ____________ NATIONALITY:________ _______
HIGHEST EDUCATIONAL ATTAINMENT: ______________________________________________________________
NAME OF SCHOOL:____________________________________________________
IDENTIFYING MARKS/CHARACTERISTICS:
DRIVER’S LIC NR: __________________________ ISSUED AT: ____________________________
ON:__________________RES CERT NR:: __________________ DATE AND PLACE OF ISSUE: ____________________
OTHER ID CARDS: ________________________________________________________ID
NR:___________________________
NAME OF FATHER: __________________________________AGE: ____________
ADDRESS:
NAME OF MOTHER: _________________________________AGE: ____________
ADDRESS:
NAME & ADDRESS OF PERSON TO BE CONTACTED IN CASE OF EMERGENCY:
NAME: ____________________________________ RELATIONSHIP:__________________
ADDRESS:_______________________________________________________TEL # _________________
LAWYER: ___________________________________________________________ TEL #: ____________________________
DOCTOR: __ ________________________________ TEL #:_____________________________
HEALTH PROBLEM: _______________________________________________________________________________________
OFFENSE CHARGE:
(NATURE OF OFFENSE) (CRIM/IS NO.)
WHERE ARRESTED
TIME AND DATE ARRESTED:
NAME OF ARRESTING OFFICER/S:
UNIT:
MEDICAL EXAMINATION CONDUCTED AT: Mandaluyong City Medical Center
BY: ON:
FINGERPRINT TAKEN BY: _________________________
PHOTO TAKEN BY:
_________________________________________________________________________________________
DUTY INVESTIGATOR: _______________________________________________
BOOKED BY (RANK/NAME/SIGNATURE):
Booked time and date: ________________
SIGNATURE OF PERSON ARRESTED: _____________________________________________________________________
(INDICATE IF SUSPECT REFUSED TO SIGN)

RIGHT HAND

THUMB INDEX MIDDLE RING LITTLE

LEFT HAND
(ATTACHED: MEDICAL EXAM; MUG SHOTS; TENPRINTS OF SUSPECTS)