Republic of the Philippines

National Police Commission

PHILIPPINE NATIONAL POLICE
CAVITE PROVINCIAL POLICE OFFICE
CASTAÑEDA MUNICIPAL POLICE STATION
Jubail Street, Barangay Tartaria, Silang, Cavite
Telefax 524-8328

INVESTIGATION DATA FORM

To be accomplished by the Office
DATE RECEIVED: NPS DOCKET:
(stamped and initialed):
Time Received: Assigned to:
Receiving Staff: Date Assigned:

To be accomplished by the complainant/counsel/law enforcer

(Use back portion if space is not sufficient)
COMPLAINANT: RESPONDENT/S:
People of the Philippines Jayvee Lurheinzo Valdez, 37 years old, born
Castaňeda MPS on March 01, 1985, single, delivery truck driver,
Represented by: native and resident of Malaluan St., Brgy.
PSMS Agbayani Bayani Tartaria, Silang, Cavite.
Jerod Bul Lim, 37 years old, born on April 01,
1985, single, delivery truck driver, native and
resident of Maginhawa St., Brgy. Tartaria, Silang,
Cavite.

LAW/S VIOLATED Witness:

Section 5 & 11 Article II of Republic Act 9165 1. Pat Brett Dales Maslang;
2. PMSg Haizaki Ybaňez;
3. Others
TIME AND DATE OF COMMISION: PLACE of COMMISSION:
OOA 8:00 AM of December 13, 2022 Malaluan St., Brgy. Tartaria, Silang, Cavite
EVIDENCES:
1. Request/Result of Laboratory Examination; to follow
-two (2) pc of heat sealed transparent plastic sachet containing with suspected shabu; under custody of
RFU 4A;
2. Affidavit of arresting officer PSMS Lamshik Surla;
3. Coordination Form;
4. Pre-Operation Report;
5. Certificate of Coordination;
6. Receipt/Inventory for Property Seized;
7. Chain of Custody;
8. Booking Arrest Sheet and Mug shots of the arrested suspect;
9. Pictures;
10. Drug Test Examination Request/Result; to follow
11. Spot Report dated September 8, 2022;
12. Blotter extract;
13. Receipt of Object Evidence.
14. Request/result of Medical Examination;
15. Others to follow;

Pat Brett Dales Maslang

(Complainant)

SUBSCRIBED AND SWORN TO before me this ___day of December 2022 in

Municipality of Silang, Province of Cavite.

Disposition:
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Prosecutor Administering Oath