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BUONG PANGALAN: _____________________________________________________________

ADDRESS: _____________________________________________________________________

PALAYAW / ALYAS: ________________________ Cellphone Number: ______________________

Edad: ______ Birthdate: _________ Place of Birth/Lugar kung saan Ipinanganak: _________________________

Relihiyon: __________________________ Height/Taas: ____________ Weight/Timbang: ______________

Sino ang iyong Abogado?: ____________________________________ Court Branch/Korte: _________________

Ikaw ba ay nakulong/detained? Oo o Hindi? ____________________

Saan ka nagkulong?________________________________________
Gaano katagal? ___________________________________________
Sino ang Custodian mo? (Barangay Official na nag custody sa iyo sa iyong paglabas)
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Edad noong nangyari ang kaso: ____________________

PAANO NANGYARI ANG KRIMEN/KASO:

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FAMILY BACKGROUND:

FATHER / TATAY MOTHER/NANAY (noong dalaga pa)

NAME / BUONG PANGALAN
DATE OF BIRTH / PETSA NG
KAPANGANAKAN
AGE / EDAD
PLACE OF BIRTH / LUGAR NG
KAPANGANAKAN
ADDRESS / SAAN NAKATIRA
RELIGION / RELIHIYON
EDUCATIONAL ATTAINMENT /
NAABOT SA PAG-AARAL
OCCUPATION / TRABAHO /
PROPESYON
WORK ADDRESS / LUGAR NG
TRABAHO
CONTACT NO.
MONTHLY BUWANANG SAHOD
DATE DECEASED / PETSA NG
PAGKAMATAY
CAUSE OF DEATH / RASON NG
PAGKAMATAY

Kumusta ang Pagsasama ng iyong mga magulang?

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KUMUSTA ANG SAMAHAN NG MGA MAGULANG MO? PAANO KA PINALAKI NG MAGULANG MO?

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SIBLINGS / MGA KAPATID (BUONG KAPATID, KAPATID SA INA O AMA)

ILAN KAYONG MAGKAKAPATID? __________________________________

PANG-ILAN KA SA MGA MAGKAKAPATID? __________________________

NAME OF DEGREE OF AGE / EDAD EDUCATIONAL OCCUPATION /

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SIBLING / RELATIONSHIP / ATTAINMENT / TRABAHO

PANGALAN NG ESTADO NG NAABOT SA PAG-
KAPATID SAMAHAN AARAL

KUMUSTA ANG SAMAHAN NINYONG MAGKAKAPATID?

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KUMUSTA ANG IYONG KARANASAN NOONG IKAW AY BATA PA?

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PERSONAL HISTORY:

CIVIL STATUS: SINGLE____ MARRIED/KASAL: ______ CLS/MAY KINAKASAMA: ______

SEPARATED/HIWALAY______ WIDOW/BALO______ ANNULLED___

BUONG PANGALAN NG ASAWA (kung babae, ilagay ang pangalan noong dalaga pa) o KINAKASAMA:

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Age: ______________ Birthdate: _________________ Place of Birth: _________________

Work/Trabaho: _______________ Work Address: _________________ Home Address: ____________

Date of Marriage: ___________ Civil Wedding or Church Wedding: ___________________

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PAANO KAYO NAGKAKILALA NG IYONG ASAWA o KINAKASAMA?

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KUMUSTA ANG RELASYON/PAGSASAMA NINYO?

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CHILDREN / MGA ANAK

NAME / DATE OF BIRTH AGE / EDAD EDUCATIONAL OCCUPATION /

PANGALAN ATTAINMENT / TRABAHO
NAABOT SA PAG-
AARAL

Kumusta ang ang iyong pamilya? Paano mo inaalagaan ang iyong pamilya? Paano mo dinisiplina mga anak mo?

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Anu-ano ang mga problema na kinakaharap ng iyong pamilya? Bakit ito naging problema?

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Ilarawan ang iyong bahay:

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ILAN KAYONG NAKATIRA SA INYONG BAHAY?_____

SINO ANG MGA KASAMA SA BAHAY?

1. _____________________
2. _____________________
3. _____________________
4. _____________________
5. _____________________
6. _____________________
7. _____________________
8. _____________________
9. _____________________
10. ____________________

KUMUSTA ANG SAMAHAN NINYO SA BAHAY?

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EDUCATIONAL HISTORY

ELEMENTARY:_______________________________________ DATE GRADUATED : ______________

HIGHSCHOOL: ______________________________________ DATE GRADUATED: _______________

COLLEGE and COURSE: _______________________________ DATE GRADUATED: _______________

VOCATIONAL and COURSE: ___________________________ DATE GRADUATED: _______________

KUMUSTA ANG PAG-AARAL MO NOON?

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SINO ANGA NAGPA-ARAL SA IYO NOON? ______________________________________________________

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EMPLOYMENT HISTORY / MGA NAGING TRABAHO (MULA SA PINAKA UNA HANGGANG SA KASALUKUYAN)

TRABAHO TAON LUGAR EMPLOYER

1. ______________________________________________________________________________
2. _____________________________________________________________________________
3. _____________________________________________________________________________
4. _____________________________________________________________________________
5. _____________________________________________________________________________

ANO ANG IYONG TRABAHO NGAYON? _______________________________________________

SAAN ANG LUGAR NG IYONG TRABAHO? _____________________________________________

ILAN ANG SAHOD MO KADA ARAW/BUWAN? ________________________________________

SAPAT BA ANG IYONG SAHOD SA PANG-ARAW-ARAW NA GASTUSIN? BAKIT?

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KUNG WALA KANG TRABAHO SA NGAYON, ANO ANG IYONG PLANO UPANG MAKAPAG TRABAHO?

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ANO ANG IYONG MABUTING KATANGIAN / UGALI?

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ANO ANG GUSTO MONG BAGUHIN SA SARILI O SA UGALI MO?

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LUGAR KUNG SAAN TUMIRA o NAMALAGI NA MAHIGIT SA ISANG TAON:

TAON RASON / LUGAR SINO ANG KASAMA/MGA KAMAG-ANAK

______ ______________________ _________________________________

______ ______________________ _________________________________

______ ______________________ _________________________________

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HEALTH STATUS / ESTADO NG KALUSUGAN

Masasabi mo ba na ikaw ay malusog? OO o Hindi. Bakit?.

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Ikaw ba ay naospital na? Oo o Hindi? __________________

Anong sakit mo noong ikaw ay naospital? _______________________________________

Saang ospital? _________________________________________

Anong petsa o taon? ____________________________________

May iniinom ka bang gamot? Ano ang mga ito? _________________________________________

Umiinom ka ba ng alak/beer/gin? Oo o Hindi? ________________________________________

Bakit ka umiinom ng alak?

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Gaano ka kadalas uminom ng alak sa isang lingo? _____________________________________

Sino ang kasama mo uminom ng alak? ______________________________________________

Ikaw ba ay naninigarilyo? Oo o Hindi? _____________________________________________

Ilang sticks ng sigarilyo / pack sa isang araw? _____________________________________________________

MAGULO BA SA INYONG BARANGAY? OO o HINDI? BAKIT?

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MAY MGA NAKAAWAY KA BA O NAKA-ALITAN SA INYONG BARANGAY?

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ANO ANG IYONG TALENTO: __________________________________________________________________

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BAKIT KA DAPAT MABIGYAN NG PROBATION?

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