EXCLUSIVE USE OF THE NATIONAL GENERAL PROSECUTOR OFFICE

CASE NUMBER
6 3 5 9 4 2 0 1 6
CAD File Number Dpmt Municipality Ent U. Receptor Year Consecutive

UNIQUE FORMAT OF CRIMINAL NOTICE -FPJ2-

This format will be filled by the servers with functions of the Judicial Police, in those events in which the action did not start
formally

Date: D/ M/ Y/ Time:

Department
Municipality

I. NOTICE TYPE

Marque con X, según corresponda:

Denouncement Is the user referred by an Entity? YES NO Date D M A

Complaint Which one?
Special Request Name of consignee
Reproduction of Charge
Records (Compulsory of
copies)

II. CRIME

CRIME
1.
2.
3.
4.

III. DATA ABOUT THE FACTS

It is stated that the complainant has been informed about: the legal obligation that any person over 18 years of age has to
report any fact that he or she has knowledge of and that the authorities must investigate in office; of the exoneration of the
duty to denounce against himself, against his spouse or permanent companion, relative in 4th degree of consanguinity,
affinity or civil, or facts that you have known in the exercise of an activity protected by professional secrecy; That the
present denunciation is carried out under the gravity of oath and about the penal sanctions imposed to whoever incurs in
false denunciation.(Articles 67 - 69 of the C.P.P. and 435 - 436 C.P.).

Date of commission of the acts D/ M/ Y/ Time

(For continuous execution offenses, fill out the following space:)

Initial date of commission of the acts D/ M/ Y/ Time

File only if it is possible to determine this date:

Final date of commission of the acts D/ M/ Y/ Time

Place of commission of the acts

Department Municipality

Location or Zone Neighborhood

Address

Specific Site

Weapons used? No Yes

Fire White Blunt Unknown Other Which

Use of toxic substances? No Yes

Account of the events (describing circumstances of time, manner and place of events):

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 IV. COMPLAINANT OR PLAINTIFF INFORMATION
(Where more than one complainant complete annex 1)

First Name Middle Name

First Last Name Second Last Name

Identifying Document C.C passport # Of

Age: Años. Gender M F Date of Birth: D M Y

Birth Place: Country Department Municipality

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Profession Occupation

Marital Status Education level

Residence address: Neighborhood:

Country Department Municipio

Notification address Neighborhood

Home Phone Office Phone

Relationship with the accused

Estimate of damages (in crimes against property): $

( )

V. VICTIM DATA
(When it is not the same plaintiff)
(When more than one victim complete annex 2)

The victim is informed of the content of articles 136 and 137 of the Code of Criminal Procedure, regarding the information
that must be known as a victim and the right to intervene in all phases of criminal proceedings in accordance with the rules
indicated in the criminal procedural norm.

First Name Middle Name

First Last Name Second Last Name

Identifying Document C.C passport Other # of

Age Years Gender: M F Birth Date: D M Y

Birth Place Country Department Municipality

Profession Occupation:

Marital Status Education Level:

Home Address Neighborhood

Country Department Municipality

Notification Address Neighborhood

Home Phone Office Phone

Relation to Plaintiff

Morphological characteristics

Data related to parents and relatives of the victim

Names Last Names Relationship Address Telephone

VI. DATA OF THE ACCUSED

(When more than one suspect fill in Annex 3)

In Investigation Yes No

First Name Segundo Nombre

First Last Name Segundo Apellido

Identifying Document C.C passport other # of

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Age: Years. Gender: M F Fecha de nacimiento: D M Y

Birth Place Country Department: Municipality

Profession Occupation

Marital Status Education Level

Home Address Barrio

Country Department Municipality

Notification Address Neighborhood

Home Phone Work Phone

Relation to Plaintiff

Alias

Marital Status Name of spouse or permanent partner

Data related to parents and relatives

Names Last Names Relationship Address Telephone

Work Place Charge

Morphological characteristics

VII. DATA RELATED TO ASSETS OF THE ACUSED

Asset Type Identification of the asset Address

Financial Offica Account Type Account Number Seat of the account

VIII. DATA OF THE WITNESSES

(When more than one witness fill out the annex 4)

First Name Middle Name

First Last Name Second Last Name

Identifying Document C.C passport other # of

Age: Years. Gender: M F Date of Birth D M Y

Birth Place Country Department Municipality

Profession Occupation

Marital Status Education Level

Home Address Neighborhood

Notification Address Neighborhood

Home Phone Work Phone

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Relation to the accused

IX. VEHICLES
(Record this information, if the act involves vehicles)

Was the vehicle stolen Yes No

Brand Tag Model

Class Service Color

Motor # Chassis #

Serial # Insured Yes No

Company Policy #

Are there other assets involved Yes No Detail them in the story of the events

Place where it is located

Signatures

Plaintiff Receiving Authority

Authority to which this decouncement will be sent:

Entity Specialty Fiscal Code

Prosecutor First and Last Name

X. INFORMATION RELATED TO THE CONCILIATION CENTER OR CONCILIATOR

(Only for complaints)

Department
Municipality

Conciliator or Conciliation Center:

Date of Receipt: D/ M/ Y/ Time

Date of dispatch: D/ M/ Y/ Time

Address:

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