Republic of the Philippines

Department of Justice
National Prosecution Office
OFFICE OF THE PROVINCIAL PROSECUTOR
Bulwagan ng Katarungan, Tacloban City
INVESTIGATION DATA FORM
To be accomplished by the Office

DATE 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 and Address:

1. Jocebel Dabalos Roda, Filipino, Female, 55 years old, and a resident of Brgy Abango, Barugo,
Leyte

WITNESS/ES: Name, Sex, Age and Address:

1. Jocebel Dabalos Roda, Filipino, Female, 55 years old, and a resident of Brgy Abango, Barugo,
Leyte

RESPONDENT/s: Name, Sex, Age and Address:

1. Raymond Miscala y Famor, Filipino of legal age and a resident of Eco-Ville

Subdivision, Carigara, Leyte

OFFENSE/s or LAW/s VIOLATED 13-counts of Estafa and 13 counts of BP 22

DATE & TIME OF COMMISSION: PLACE OF COMMISSION:

January 2022 to June 2022 Brgy Abango, Barugo, Leyte

1. Has similar complaint been filed before any other office? YES____ NO
2. Is this complaint in the nature of a counter-charge? YES____ NO If yes, indicates details below.
3. Is this complaint related to another case before this office? YES____ NO If yes, indicates details below.

NPS Docket No._______________________________

Handling Prosecutor____________________________

CERTIFICATION
I CERTIFY under oath that all the 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 issues in any court,
tribunal or quasi-judicial agency, that 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 from knowledge thereof.

PEMS NOEL B CORAL

Investigator on Case

SUBSCRIBED AND SWORN to before me this day of September 2022 at Tacloban City, Leyte,
Philippines.

_________________________
Administering Officer