Republic of the Philippines

DEPARTMENT OF JUSTICE
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
San Pablo City, Laguna

Name /Unit of Referring LEAs or Complaint NPS Docket No. IV _______

- Versus - - for –
_________________________
Name of Respondents/persons subject of complaint
x- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - x

REPORT
(Preliminary Evaluation for complaint referred for Preliminary Investigation/Inquest)

I, _______________________________, Asst. City Prosecutor assigned at Office of the

City Prosecutor, San Pablo City, Laguna.

That pursuant to DOJ Circular No. 020, I conducted the required preliminary evaluation
of the above-numbered complaint referred to our office for Preliminary Investigation/Inquest.

That, submitted to our office in support of the complaint are the following documents, to
wit:
1. ___________________________________
2. ___________________________________
3. ___________________________________

That, after conducting the Preliminary Evaluation, I issued a Certification containing my

findings and recommendation which was duly approved by City Prosecutor Rockefeller G.
Cueto. Said certification is here to attached as Annex ___________.

That, a case conference for the case buildup was conducted:

That, the LEAs/Complainant/s were directed to submit within 10 days or on or before

_______________________________________ additional evidence, to wit:
1. __________________
2. __________________
3. __________________

That, LEAs/Complainant failed to submit/comply within the period.

Hence, it is respectfully recommended that the instant complaint be considered

closed/terminated without prejudice to the refiling once the pieces of evidence will be
completed/submitted.

City of San Pablo, Province of Laguna, Philippines, ______________________, 2023

Name and Signature of Prosecutor

Approved:

ROCKEFELLER G. CUETO
City Prosecutor