NPS Investigation Form No.

01 s 2008
Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
Regional Trial Court of Malolos
City of Malolos, Bulacan

INVESTIGATION DATA FORM

To be accomplished by the Office:

DATE RECEIVED: NPS DOCKET NO:

(Stamped and Initiated)_________________________ __________________________________________
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 & Address RESPONDENT/S: Name, Sex, Age & Address

VICTIM/S: SUSPECT/s:

Contact No.:
OFFENSE/S COMMITTED/ LAW/S VIOLATED: WITNESS/ ES NAME / ADDRESS
___________________________________
1.
2. 3.

DATE & TIME OF COMMISSION: PLACE OF COMMISSION

1. Has a similar complaint been filed before any other office? YES ____ NO _/__
2. Is this complaint in nature of counter-charge? YES ____ NO _/__
3. Is this complaint related to another case before this office? YES ____ NO _/__
I.S/NPS Docket No. ____________________________
Handling Prosecutor____________________________

CERTIFICATION
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 same issues in any
court, tribunal or quasi-judicial agency, and that if I should thereafter learn a similar action has been filed and or is

pending, I should report the fact to this Honorable Office within (5) days from knowledge thereof.

___________________________
(Signature over Printed Name)

SUBSCRIBED AND SWORN TO before me this ___ th day of April 2023 at Prosecutor’s Office, City of
Malolos, Bulacan.

_________________________________
Asst. Provincial Prosecutor
 Republic of the Philippines
NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE, POLICE REGIONAL OFFICE 3
BULACAN POLICE PROVINCIAL OFFICE
MARILAO POLICE STATION
Poblacion 1, Marilao, Bulacan
Marilaomps_bulppo_r03@yahoo.com
044-248-91-66/044-322-0596

_______________
The Director
Bulacan Medical Center
City of Malolos, Bulacan
(Attn.: Record Section)

Sir/Madam:

For legal reasons may we request from your good office a copy of Medico-Legal Result which
was conducted to the living body of one (1) ______________________, male, 44 years old born on
November 11, 1978 in Tondo Manila, single, unemployed and resident of
____________________________. Said person was arrested for ________________________on
______________________, at _____________________________________.

Furnish as a copy of Medico Legal Result to be use for our investigative purposes.

Hoping for your utmost consideration regarding this matter.

____________________________
Duty Investigator

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
______________________________________
_______________________

(DATE)

The Honorable City Chief Prosecutor

Office of ________ Prosecutor
Justice Hall, _______

(Attn: Duty Inquest Prosecutor)

Greetings :

I have the honor to refer to your Office, the records of investigation relative to the case
of (crime), committed at about ______ of ________ at ______________.

COMPLAINANT : (Name, age, nationality, civil status and current address)

VICTIM : (Name, age, nationality, civil status and current address)

SUSPECT (ARRESTED/DETAINED) :
(Name, age, nationality, civil status and current address)

EVIDENCE RECOVERED :

FACTS OF THE CASE:

Investigation disclosed....

ENCLOSURES :

a) Subscribed NPS Investigative Data Form

b) SS of the complainant
c) SS of witness
d) SS of witness
e) Joint Affidavit of Arrest of
f) Medico-Legal Report
g) As stated evidence recovered
g) Death Certificate of the Victim
i) Anatomical Sketch of the Victim
j) Booking and Information of the suspect
k) And others to be presented later.

This case will be presented to you by (Name of Investigator-on-Case) of this Office

during the course of inquest proceedings. Further, request furnished this Office copy of
resolution of the case and other proceedings.

For appropriate action and disposition.

___________________________
Chief of Police