Republic of the Philippines

NATIONAL POLICE COMMISSION

PHILIPPINE NATIONAL POLICE
CAGAYAN POLICE PROVINCIAL OFFICE
APARRI POLICE STATION
Aparri, Cagayan

FIRST RESPONDER FORM

(This form shall be brought by the 1st responder and/or investigator at the crime scene and shall be
accomplished by the first responders at the On Scene Command Post OSCP).

DATE

THISIS TO CERTIFY that the crime scene (CS) described hereunder was turned over by the first
responder (FR) to the duty investigator/ Investigator-On-Case (OIC) with the gathered information.

Primary Place Occurrence: Kalbo St., Brgy. Bumbay, Aparri, Cagayan

Type/Nature of Incident: Murder
Rank and Names of First Responder: Pat.John Paul Antonio, Pat. Jay Mark Monroy
Time/Date Report of Incident was received by FRs: 7:35 AM October 8, 2022
Time FR's arrived at the Crime Scene: 7 40 AM October 8, 2022
Weather Condition: Broad Day light
Time CS Cordoned Off and Secured/Signs Posted: 7:42 AM
Time Flash Alarm/Request for Support Relayed by FR to TOC: 7:45AM

A. Names of Victims and Status: (Safe/Injured/Hospitalized/Deceased, etc.):

Jackie Chan
Status: (Deceased)

B. Names of Persons found at(inside)the Crime Scene by FR (Address, Contact No.):

Pedro Penduko y Magtanggol Jr
Address- Kalbo St., Brgy. Bumbay, Aparri, Cagayan
Contact No- 09123456789

C. Names of Suspects and Status (Arrested/At large, etc.) and Weapons, if any:
Junjun Awatukwartu y Fappaga( At large)

D. Name of Person Found Near or at the Vicinity of CS (Address/Contact No.):

John Karl Jose
Address- Kalbo St., Brgy. Bumbay, Aparri, Cagayan
Contact No- 09123456789
E. Name of Persons Interviewed by the FR (Address/Contact No):

Ross Bernard Garcia

Address- Kalbo St., Brgy. Bumbay, Aparri, Cagayan
Contact No- 09123456789

F. Names of Persons Who Entered the CS after the Arrival of FR and Prior to Arrival of
Investigator (Medics. Local Officials. etc) (Address/Contact Nr):

N/A

(Note: use the overleaf or back page for extra entries)

G. List Of Evidence That May Have Been Seized or Collected by the FR (if Any):

Description Disposition

N/A N/A

H. Areas where Initial Search were conducted:

Kalbo St., Brgy. Bumbay, Aparri, Cagayan

This further certifies that the Crime Scene and all the evidence therein by the FRs have
been properly secured and preserved and that all information contained herein is true and correct
to the best of our ability:

Name and Signature of First Responders:

Pat. John Paul Antonio -

Pat. Jay Mark Monroy -

CS Received By Duty Investigator/IOC

PSSg. Stephen Estal

Witnessed By:
Kag. Bernard Garcia

Prepared and Submitted by:

PSSg. STEPHEN ESTAL

Rank/Name/Designation of Office/Signature over Printed Name