FOR POLICE BLOTTER ENCODER USE ONLY

Philippine National Police

BLOTTER ENTRY NUMBER

021564548

TYPE OF INCIDENT
Robbery

INSTRUCTIONS: Refer to PNP SOP on ‘Recording of Incidents in the Police Blotter’ in filling up this form. This Incident Record Form (IRF) may be reproduced, photocopied,
and/or downloaded from the DIDM website, www.didm.pnp.gov.ph.
DATE AND TIME REPORTED: DATE AND TIME OF INCIDENT:
December 01,2021 11:30 am November 30,2021 02:00 am ITEM “A” - REPORTING PERSON
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
CARLOS John Benedict Sucaldito N/A BJ

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
Filipino Male Single September 21, 1986 35 Tondo, Manila 145-2568 09564564823

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

Purok 14 Number 422 Malaya Street Sitio Dela Muchos 154 Manila Ilocos

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

N/A N/A N/A N/A N/A

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION ID CARD PRESENTED EMAIL ADDRESS (If Any)
COLLEGE Businessmen SSS ID johnbenedict@gmail.com

ITEM “B” - SUSPECT DATA

 CHECK HERE IF THERE IS NO SUSPECT INVOLVED AND THEREAFTER PROCEED TO ITEM “C”.
 CHECK HERE IF THERE ARE TWO OR MORE SUSPECTS. THEREAFTER, USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR EACH OF THE SUSPECTS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
SANTOL JOSE MARI CHAN N/A BUNGAL

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
FILIPINO MALE SINGLE JUNE 04,1998 23 CALOOCAN N/A N/A

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

PUROK 85 SITIO ARKIEL 585 CALOOCAN N/A

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

N/A N/A N/A N/A N/A

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS RELATION TO VICTIM EMAIL ADDRESS (If Any)
HIGH SCHOOL N/A N/A NONE N/A

IF AFP/PNP PERSONNEL: RANK UNIT ASSIGNMENT GROUP AFFILIATION WITH PREVIOUS CRIMINAL RECORD? [ YES] Yes [ ] No STATUS OF PREVIOUS CASE
N/A N/A N/A (If Yes, Pls. Specify) ROBBERY PENDING

HEIGHT WEIGHT COLOR OF EYES DESCRIPTION OF EYES COLOR OF HAIR DESCRIPTION OF HAIR UNDER THE INFLUENCE?
144 CM 68 KG BROWN N/A BLACK PURE BLACK LONG HAIR  NO  DRUGS  LIQUOR
 OTHERS

FOR CHILDREN IN CONFLICT WITH THE LAW

NAME OF GUARDIAN GUARDIAN ADDRESS HOME PHONE MOBILE PHONE
N/A N/A N/A N/A

DIVERSION MECHANISM N/A

OTHER DISTINGUISHING FEATURES (DESCRIBE IN DETAIL CLOTHES, VEHICLE, SUNGLASSES, WEAPON/S, SCARS, AND OTHER DATA OR ACTIVITY OF THE SUSPECT/S WHICH WERE OBSERVED BY THE
REPORTING PERSON AND/OR WITNESS/ES TO IDENTIFY THE SUSPECT/S. THESE ARE IMPORTANT AND MAY BECOME EVIDENCE TO IDENTIFY, AND LINK TO THE CRIME, THE SUSPECT/S. USE ADDITIONAL
SHEET/S IF NECESSARY)

CUT HERE. ISSUE THIS RECEIPT TO THE REPORTING PERSON

BLOTTER ENTRY NUMBER

NAME OF REPORTING PERSON: John Benedict Carlos ADDRESS OF REPORTING PERSON:

THIS CERTIFIES THAT Purok 14 Number 422 Malaya Street Sitio Dela Muchos 154 Manila
REPORTED AN INCIDENT TO BE TYPE OF INCIDENT: Robbery
RECORDED IN THE POLICE BLOTTER
WHICH INVOLVES AND
DATE/TIME OF REPORT: DATE/TIME OF INCIDENT: PLACE OF INCIDENT: RECORDED BY: Police Officer Romnese Santiago
December 01,2021 11:30 am November 30,2021 02:00 am Recto Manila

RANK/NAME/SIGNATURE OF DESK OFFICER

 ITEM “C” – VICTIM DATA
CHECK HERE IF THE REPORTING PERSON (ITEM “A”) IS THE VICTIM. PROCEED TO ITEM “D”.
 CHECK HERE IF THERE ARE TWO OR MORE VICTIMS. USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR THE DATA OF THE ADDITIONAL VICTIMS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)

ITEM “D” - NARRATIVE OF INCIDENT

BLOTTER ENTRY NUMBER TYPE OF INCIDENT TIME DATE PLACE OF INCIDENT
021564548 Robbery 02:00 am November 30,2021 Recto Manila

ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING. (USE ADDITIONAL SHEET/S IF NECESSARY)

- It was around 02:00 am in the midnight where John Benedict Carlos, Victim, are currently going home after his shift. While waiting for a jeepney, Jose Mari Santol, Accused, are roaming around
the area. The victim is using his brand new phone amounting to 50 thousand pesos, caught the attention of the accused. The victim are carrying a gun which threatened the victim and after 2
minutes of talking with the accused, the victim surrender his phone and his wallet. The victims knows the identity of the accused as there was a CCTV footage around the area. The victim was
showed several pictures of most wanted criminals in the area, and confirmed that the accused was Jose a.k.a bungal.

(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)

I HEREBY CERTIFY TO THE CORRECTNESS OF THE NAME/SIGNATURE OF REPORTING PERSON NAME/SIGNATURE OF DESK OFFICER
FOREGOING TO THE BEST OF MY KNOWLEDGE AND
BELIEF. John Benedict Carlos Police Officer Romnese Santiago

CASE DISPOSITION (For Chief/Head of Office Use Only)

CHIEF Of STATION/OFFICE INSTRUCTIONS NAME OF DESIGNATED INVESTIGATOR-ON-CASE NAME OF CHIEF OF STATION/OFFICE
PBGEN ANTONIO CANDIDO YARA Police Officer Romnese Santiago PBGEN ANTONIO
CANDIDO YARA
-----------------------------CUT HERE--------------------------------------------------------------------------------------CUT HERE------------------------------------------------------
INSTRUCTIONS TO REPORTING PERSON
Keep this Incident Record Transaction Receipt (IRTR). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRTR. For your reference, the data below is the contact details of this police station.
Quezon City Police Station 478-0145
Name of Police Station Telephone
Police Officer Romnese Santiago 0975-1458-655
Investigator-on-Case Mobile Phone
Name of Chief/Head of Chief Philip Ines 0978-1456-222
Mobile Phone
Office