FOR POLICE BLOTTER ENCODER USE ONLY

BLOTTER ENTRY NUMBER

2438-8768175-12778
Philippine National Police
TYPE OF INCIDENT
Physical Injury INCIDENT RECORD FORM
INSTRUCTIONS: Refer to PNP SOP on ‘Recording of Incidents in the Police Blotter’ in filling up this form. This Incident Record Form (IRF) may be reproduced, photocopied,
and/or downloaded from the DIDM website, www.didm.pnp.gov.ph.
DATE AND TIME REPORTED: DATE AND TIME OF INCIDENT:
06-14-2023/1445H 06-14-2023/1455H ITEM “A” - REPORTING PERSON
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
Magsagilpoc Horacio Curacpao JR Otob
CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
Filipino M S 06-12-2003 19 Ligao City 09286783456
CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

P5 Iglesia St Sitio Tambac Maonon Ligao Albay

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION ID CARD PRESENTED EMAIL ADDRESS (If Any)

College Graduate PNP PNP ID kusitpuke@gmail.com

ITEM “B” - SUSPECT DATA

CHECK HERE IF THERE IS NO SUSPECT INVOLVED AND THEREAFTER PROCEED TO ITEM “C”.
CHECK HERE IF THERE ARE TWO OR MORE SUSPECTS. THEREAFTER, USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR EACH OF THE SUSPECTS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
Kian Cipriano Lambroso Kito
CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
filipino Male Single March 24, 2023 20 Ligao City
CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
Purok 5 Mahabang Alaba Mahaba Ligao City Albay
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
N/A N/A N/A
HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS RELATION TO VICTIM EMAIL ADDRESS (If Any)

High School Graduate N/A N/A N/A

IF AFP/PNP PERSONNEL: RANK UNIT ASSIGNMENT GROUP AFFILIATION WITH PREVIOUS CRIMINAL RECORD? [ ] Yes [ ] No STATUS OF PREVIOUS CASE
N/A (If Yes, Pls. Specify)
N/A None N/A
HEIGHT WEIGHT COLOR OF EYES DESCRIPTION OF EYES COLOR OF HAIR DESCRIPTION OF HAIR UNDER THE INFLUENCE?
NO DRUGS LIQUOR
5'6" 40 kg. Black Round Black Long Hair OTHERS ________________________

FOR CHILDREN IN CONFLICT WITH THE LAW

NAME OF GUARDIAN GUARDIAN ADDRESS HOME PHONE MOBILE PHONE

DIVERSION MECHANISM

OTHER DISTINGUISHING FEATURES (DESCRIBE IN DETAIL CLOTHES, VEHICLE, SUNGLASSES, WEAPON/S, SCARS, AND OTHER DATA OR ACTIVITY OF THE SUSPECT/S WHICH WERE OBSERVED BY THE
REPORTING PERSON AND/OR WITNESS/ES TO IDENTIFY THE SUSPECT/S. THESE ARE IMPORTANT AND MAY BECOME EVIDENCE TO IDENTIFY, AND LINK TO THE CRIME, THE SUSPECT/S. USE
ADDITIONAL SHEET/S IF NECESSARY)

--------------------------------------CUT HERE. ISSUE THIS RECEIPT TO THE REPORTING PERSON-------------------------------------------

BLOTTER ENTRY NUMBER
THIS CERTIFIES THAT
REPORTED AN INCIDENT TO BE
RECORDED IN THE POLICE BLOTTER
WHICH INVOLVES
DATE/TIME OF REPORT:
06-14-2023/ 1455H
INCIDENT RECORD TRANSACTION RECEIPT
NAME OF REPORTING PERSON: ADDRESS OF REPORTING PERSON:
PSSg Horacio C Magsagilpoc P 5 Sitio Tambac, Manon, Ligao City
TYPE OF INCIDENT:
Robbery Incident ( Hold-Up) AND
DATE/TIME OF INCIDENT: PLACE OF INCIDENT: RECORDED BY:
PSSg Ryan C Agoncillo
06-14-2023/ 1445H P1 Brgy Busay, Ligao City RANK/NAME/SIGNATURE OF DESK OFFICER
 ITEM “C” – VICTIM DATA
CHECK HERE IF THE REPORTING PERSON (ITEM “A”) IS THE VICTIM. PROCEED TO ITEM “D”.
CHECK HERE IF THERE ARE TWO OR MORE VICTIMS. USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR THE DATA OF THE ADDITIONAL VICTIMS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (DD/MM/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)

ITEM “D” - NARRATIVE OF INCIDENT

BLOTTER ENTRY NUMBER TYPE OF INCIDENT TIME DATE PLACE OF INCIDENT
B-894-2023 Robbery Incident (Hold-Up) 1445H 6-14-2023 P1 Brgy Busay, Ligao City
ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING. (USE ADDITIONAL SHEET/S IF NECESSARY)

At about 2:45 AM of June 14,2023 PSSg Horacio C Magsagilpoc and PCpl Gregorio S Oten, Intel Operative of
Ligao City Police Station conducted intel monitoring particularly at the place of Brgy. Busay of this City and they
pretend to hang out at the nipa hut in the middle of rice fields of Purok 1 Brgy. Busay Ligao City when suddenly
two (2) unidentified male persons riding in their motorcycle approached them and pointed a gun and knife and
declre hold up but the police officer realized that the gun was fake so they also poked a hand gun to the dou but
suddenly the suspects run in the middle of the rice fields and later PSSg Horacio C Magsagilpoc caught one male
person and was identified as Kian Cipriano Y Lambroso, 20 years old, single, unemployed and a resident of
Purok 5, Brgy. Mahaba, Ligao City and recovered to his possession a bladed weapon (knife), while his other
companion escaped and fell down the hand gun at the rice field and recovered it by PCpl Grogorio S Oten later
on it was found out that the hand gun was faked. Subject arrested person has no existing warrant of arrest upon
verification at e-Warrant System

(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)

AUTHENTICATION
I HEREBY CERTIFY TO THE CORRECTNESS OF THE NAME/SIGNATURE OF REPORTING PERSON NAME/SIGNATURE OF DESK OFFICER
FOREGOING TO THE BEST OF MY KNOWLEDGE AND
PSSg Horacio C Magsagilpoc PSSg Ryan C Agoncillo
BELIEF.

CASE DISPOSITION (For Chief/Head of Office Use Only)

CHIEF Of STATION/OFFICE INSTRUCTIONS NAME OF DESIGNATED INVESTIGATOR-ON-CASE NAME OF CHIEF OF STATION/OFFICE
PMSg Thed F Iglesia PLTCOL JOSEPH P NAMORO

-----------------------------CUT HERE--------------------------------------------------------------------------------------CUT HERE------------------------------------------------------

INSTRUCTIONS TO REPORTING PERSON
Keep this Incident Record Transaction Receipt (IRTR). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRTR. For your reference, the data below is the contact details of this police station.

Name of Police Station Ligao City Police Station Telephone 049-2738

Investigator-on-Case PMSg Thed F Iglesia Mobile Phone 0947-123-4567
Name of Chief/Head of
Office
PLTCOL JOSEPH P NAMORO Mobile Phone 0981-868-8763