Different Kinds of FORMS...

(1) Sample Format of Spot Report in Memorandum Form:
Republic of the Philippines

National Police Commission
Philippine National Police
___________________________
MEMORANDUM
TO :
FROM :
SUBJECT : SPOT REPORT
DATE :
(Indicate briefly the time, date, and place of occurrence)
(Brief facts of the case)
(Other facts)
Request/recommended actions from Hqs.
Progress Report will follow
___________________
(2) Actual Sample of Spot Report in Memorandum Form

CEBU CITY POLICE OFFICE
POLICE STATION 4
Juan Luna Extn., Mabolo, Cebu City
Tel No.: 231-5411; Email: ro7 cebucpo ps4@yahoo.com
MEMORANDUM
FOR : CITY DIRECTOR

Cebu City Police Office
Camp Sotero Cabahug,
Gorrodo Avenue, Cebu City
(Attn: Opns Branch)
SUBJECT : SPOT REPORT re Arrested Suspect for Theft (Snatching) Alarm
DATE : October 19, 2012
1. Please be informed that OOA 04:50 PM of October 19, 2012 at Carmelite

Monastery, J. Luna St., Mabolo Cebu City one ______________ 25 years old, single,
a resident of Bonifacio, Barangay Pari-an Cebu City was arrested at the said place,
time and date after the victim was riding a passenger jeepney, suddenly the minor
snatched his above mentioned item/article and handed it his companion as the
Second suspect. But one PO1 Tubalde, Russeline R. an FTP of LLCPO, witnessed
and saw the incident. The said FTP responded and apprehended the suspect. The
item was recovered at the suspect’s possession. Thus caused of his arrest.
2. Victim was represented by ________________ 20 years old, single, a resident of

Bonifacio, Brgy. Ballang, Davao City, with contact No. _______________
3. Recovered from the suspect possession one (1) Unisilver Necklace 925 - Worth
P750.00
4. Progress report will follow.
5. For information and request acknowledge receipt.
ENRIQUE LIMBAGA BELCIÑA, CSP

P
olice Chief Inspector
O
fficer-In-Charge
(3) Actual Sample of Spot Report in Radio Message Form
RAD MSG FOR XMSN
FM : CCMA STN 5 RESTD
FOR : OIC CMA MCPO (ATTN: OPN SEC) “P”
CNR : STN5C – 08 – 05 – 09 – 03 PD 05 AUG. 09
SPOT REPORT RE ARRESTED PERSON FOR VIOL OF PAPA DELTA 1619 PD THAT ON
OR ABOUT 042230H AUGUST 09 ONE (1) _____________________
CMA 23 YRS OLD CMA SINGLE CMA RES AT PUROK TAMBIS BRGY UMAPAD MANDAUE
CITY PD WAS ARRESTED BY VERLADE DEMAPE CMA ZOSIMO LUAGE CMA ROFINO
MONACHIO CHA ELPIDIO DECHOS CMA AND ROQUITO DIONISIO ALL BTB MEMBER OF BRGY
UMAPAD THIS CITY PD SAID SUSPECT WAS ARRESTED INFLAGRANTE DELICTO SNLFFING
AND HAVING IN HIS POSSESSION CONTROL AND CUSTODY ONE(1) PLASTIC CELLOPHANE
CONTAINING YELLOWISH SUBSTANCE BELIEVE TO BE ALPHA RUGBY PD SAID EVIDENCE
NOW MARKED AS "JCM" TO BE SUBMITTED AT THE REGIONAL CRIME LAB OFFICE PD
SUSPECT TEMPORARILY DETAINED AT THIS OFFICE READY FOR FILLING OF CHARGES IN
THE PROPER COURT PD PROGRES REPORT WILL FOLLOW PD REQUEST ACKNOWLEDGE
RECIEPT BT END. . .
ALFREDO GUMINANG ORTIZ

Police Senior Inspector
(4) Sample Format of Special Report in Memorandum Format

CEBU POLICE PROVINCIAL OFFICE
Doña ModestaSingsonGaisano St., Lahug, Cebu City
SRPS-IN
MEMORANDUM
FOR :
FROM :
SUBJECT : SPECIAL REPORT ON ____________
DATE :
Reference
(State significant incident, place of occurrence, specific month, day,

year, name and other personal circumstance of the suspect)
(State how the incident occurred, why the incident happened, and result
of consequence of the incident.
(Other information relevant to the incident which may answer another

set of 5W’s and 1H
(Police action conducted-search, follow-up, pursuit operations, filing of

charges, further investigation.
Other developments regarding the incident shall be submitted as soon

as obtained.
_______________
___________________
(5) Sample Format of Special Report in Civilian Letter Format

NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE
CEBU POLICE PROVINCIAL OFFICE
Doña ModestaSingsonGaisano St., Lahug, Cebu City
SRPS-IN
November 16, 2006

MICHAEL DASIGAO
Governor
Cebu Province
Sir:
This pertains to the (what-significant incident) _________________

that transpired at (where-place of occurrence) perpetrated by (who-name
and other personal circumstances of the suspect) on (when-month, date
and year) at (specific time) in the (morning, afternoon, evening).
Report revealed that (how the incident occurred and why the incident
happened) resulted in (result or consequence of the incident).
Further investigation disclosed that (other information relevant to the

incident, which may answer another set of 5Ws and 1H, if necessary).
Elements of (unit taking action) are/have (police action conducted-

search/follow-up/ pursuit operations, filing of charges, further
investigation, etc.) that resulted in the result of police action- seizure,
arrest surrender, confiscation, recovery, issuance of arrest warrant, etc.)
Other developments regarding the incident shall be submitted as

soon as obtained.
Respectfully yours,
BEINARC JOHN CANETE

Police Senior Superintendent
Provincial Director
(6) Sample Format of Beat Inspection Report in Memorandum Form
REPUBLIC OF THE PHILIPPINES

CEBU METROPOLITAN DISTRICT COMMAND
HEADQUARTERS CEBU CITY POLICE STATION 1
F. Ramos Supermarket Building, Cebu City
CCPSI-D1
FOR :
FROM :
SUBJECT : Beat Inspection Report
DATE :
Submitted is the Beat Inspection Report from (time and date) ________
Time Inspected Team Personnel on Beat Place

_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
_____________ _______ ________________ ______
Following Beat were replaced by the reserves for reasons indicated:
Request acknowledge receipt.
_______________
Duty Inspector
(7) Sample Format of Patrol Report

LAPU-LAPU CITY POLICE STATION
Barangay Pusok, Lapu-lapu City
Telephone No. (032) 341-1311
PATROL REPORT
1st Shift Tour of Duty _________________________________ Date _____
CREW:
Team Leader _________________________________________________
Member _____________________________________________________
Member _____________________________________________________
Driver ___________________________________ Car No. _____________
Time Location Purpose/Events Person Contacted

_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
_____ __________ ________________ ______________
______________________
(Signature Team Leader)
(8) Actual Sample of Beat Inspection Report

MANDAUE CITY POLICE OFFICE
Police Station 4
Brgy. Casuntingan, Mandaue City
Tel. no. (032) 344-7752
MEMORANDUM
FOR : City Director

Mandaue City Police Office
Mandaue City
(Attn: C, Opns Brand C, CIB)
FROM : Chief, Police Station 4, MCPO
SUBJECT : Beat Inspection Report
DATE : 29 July 2012
1. That on or about 800H 23 July 2012, some personnel of this station

composed of PI JIMMY ETULLE FORTES, SPO4 Marissa Basiga, PO2 Jim
Patoc and PO1 Richard Cabillo conducted a patrol under the Maguikay Fly-over.
2. During the said patrol, two (2) motorcycles were apprehended for
violation of RA 4136 however, all were released after having been issued a
Temporary Operator Permit.
3. The said patrol ended at about 1000H of same date with no untoward
incident occurred.
4. For info.
JIMMY ETULLE FORTES

Police Inspector
(9) Sample format of After Operation Report

Department of the Interior and Local Government
_________________________________________
____________________________
MEMORANDUM
FOR :
FROM :
SUBJECT : After Operation Report
DATE :
I. Authority
II. Mission
III. Period Covered
IV. Area of Operations
V. Participating Elements
VI. Chronological Events

a. Background
b. Intelligence Build-up
c. Narrative account of operational activities
VII. Comments
VIII. Assessment.
______________________
(10) BOOKING OF ARRESTED SUSPECTS FLOW CHART
SUSPECT IS ARRESTED
ARRESTING OFFICER BRINGS THE

SUSPECT TO THE POLICE STATION
DESK OFFICER ENTERS INTO THE

BLOTTER THE ARREST AND
PREPARES REQUEST FOR MEDICAL
EXAMINATION OF SUSPECTS
ARRESTING OFFICER BRINGS

SUPECTS TO THE GOVERNMENT
HOSPITAL FOR MEDICAL
EXAMINATION
ARRESTING OFFICER BRINGS BACK

SUSPECTS TO STATION AND
ACCOMPLISH ARREST AND BOOKING
FORMS
ARRESTING OFFICER REFERS THE

SUSPECTS TO THE DUTY
INVESTIGATOR
DUTY INVESTIGATOR ASSISTS

PREPARATION OF BOOKING FORMS
AND TAKES THE TENPRINTS AND MUG
SHOTS
DUTY INVESTIGATOR TURNS OVER

THE SUSPECTS TO THE DUTY JAILER
DUTY JAILER TAKES CUSTODY OF

THE SUSPECTS AND PLACE THEM
IN THE LOCK-UP CELL
(11) Sample form of Booking Sheet and Arrest Report

CEBU METROPOLITAN DISTRICT COMMAND
HEADQUARTERS CEBU CITY POLICE STATION 1
F. Ramos Supermarket Building, Cebu City
1 PMFCE -
BOOKING SHEET AND ARREST REPORT
Name: ________________________________________ Date: __________

(Last) (First) (Middle)
Address: __________________________________ Time Booked: ________
Place of Birth: ____________________________ Date of Birth: ___________
Sex: __________ Marital Status: ____________ Occupation: _____________
Weight: _______ Height: __________ Age:______ Education: ____________
Scars and Marks: _______________________________________________
Other Identifying Characteristics: ___________________________________
Name and Address of Father: _____________________________________
Name and Address of Mother: _____________________________________
Name and Address of Nearest Relative: _____________________________
Offense Charged: ______________________________________________
Arrested by: _________________________ Unit: ____________________
Where Arrested: _______________ Date/Time Arrested: ________________
Booked by: _________________________ Br/Sec: ____________________
Facts known to Arresting Officers: __________________________________
_____________________________________________________________
Signature of Person Arrested: _________________
Arresting Officer: ____________________________
Right
(Thumb) (Index) (Middle) (Ring) (Little)
Left
Signature of Person Fingerprinted:

___________________
(12) PNP Booking Form – 4 “Jailer’s Receipt of Suspects” Form

_________________________________________
_________________________________
Blotted Entry Nr: _________________________ Date ______________
JAILER’S RECEIPT OF SUSPECT/S
This is to certify that the following arrested suspect/s identified as indicated:
Name: _____________________________________________________________
Address: ___________________________________________________________
Sex: __________ Age: _____________ DOB: ______________ POB ___________
Name: _____________________________________________________________
Address: ___________________________________________________________
Sex: __________ Age: _____________ DOB: ______________ POB ___________
Name: _____________________________________________________________
Address: ___________________________________________________________
Sex: __________ Age: _____________ DOB: ______________ POB ___________
Name: _____________________________________________________________
Address: ___________________________________________________________
Sex: __________ Age: _____________ DOB: ______________ POB ___________
Who was/were arrested by the (Rank/Name) ______________ ____________ ______

____________________________ (designation) _________________________,
on ________________ 20 ______ at _______________________________________
______ were turned over by (rank/name) ________________________ (designation)
____________________ on _____________________ (time/date) to the Duty Jailer.
This further certifies that the arrested suspect/s have been examined by Dr. ____
_________________________ on _______________ at _______________________
_________ (attached copy of Medical Examination results )
____________________________________
Rank/Name/Signature of Arresting Officer/s
or _________________________________
Rank/Name/Signature of Duty Investigator
Time/Date: _________________________
___________________________________
Rank/Name/Signature of Duty Jailer
Time/Date __________________________
____________________________________
Rank/Name/Signature of Witness
(13) Actual Sample of Certificate of Detention

POLICE REGIONAL 7
REGIONAL ANTI–ILLEGAL DRUGS
SPECIAL OPERATIONS TASK GROUP 7
Camp Sergio Osmeña Sr., Osmeña Blvd., Cebu City
August 27, 2008
CERTIFICATE OF DETENTION
To Whom It May Concern:
This is to certify that the following arrested persons were detained at this Police
Office for violation of Republic Act 9165, to wit:
a. ________________________ 42 yrs. old, married of Kalawisan, Lapu-lapu City.
b. _______________________ 36 yrs. old, married of Bankal, Lapu-lapu City.
c. ______________________ 29 yrs. old, married of Babag II, Lapu-lapu City.
Further certify that the aforementioned persons are mentally and physically fit (Med.
Cert. hereby attached) and is issued for COMMITMENT to Lapu-lapu City Jail.
MARVIN BARBA SANCHEZ

Police Superintendent
Executive Officer, RAIDSOTG7
(14) Sample Released Order (NPS Form 2)

DEPARTMENT OF JUSTICE
NATIONAL PROSECUTION SERVICE
PROVINCIAL/CITY PROSECUTION OFFICE
OF _____________
__________________,
Complainant,
-versus- I.S. No. ____________
__________________, For: _______________
Respondent.
X____________________x
RELEASER ORDER
(Of Detained Person)
___________
___________
Unless otherwise detained for some other legal cause, you are hereby
directed to release the person of _____________ who is presently under your
custody in connection with the above-captioned case appearing that: (Check
appropriate box/boxes and affix your initial.)
Respondent was not lawfully arrested pursuant to the

provisions of Section 5, Rule 113 of The Rule on Criminal Procedure
The documents required by the undersigned have not

been submitted by the police investigating officer.
There exist no probable cause on the basis of the

evidence presented
In this connection you are hereby directed:
To serve upon the above mentioned respondent the

attached subpoena together with the copies of the charge
sheet/complaint, affidavit and other supporting document/evidence.
To file the corresponding case with this Officer for

regular preliminary investigation.
_________________________, Philippines. ____________ 20__________.
__________________________
Inquest Prosecution
(Signature over printed name)
Approved:
___________________________
City/Provincial Prosecutor
Received copy this _____ day of _________________ 20_____.

Copy received by: ____________________________________________
Investigating/Police Officer
(15) Sample Form of Turn-Over of Arrested Suspect

Depart of the Interior and Local Government
______________________________________
______________________________
TURN-OVER OF ARRESTED SUSPECT
BLOTTER ENTRY NR: ______________________ Date _____________
This is to certify that the following arrested suspect/s identified as indicated:
Name: _____________________________________________________________
Address: ___________________________________________________________
Sex: __________ Age: _____________ DOB: ______________ POB ___________
Name: _____________________________________________________________
Address: ___________________________________________________________
Sex: __________ Age: _____________ DOB: ______________ POB ___________
Name: _____________________________________________________________
Address: ___________________________________________________________
Sex: __________ Age: _____________ DOB: ______________ POB ___________
Name: _____________________________________________________________
Address: ___________________________________________________________
Sex: __________ Age: _____________ DOB: ______________ POB ___________
Who was/were arrested

On ____________________________ 20 ____ at ___________________ (time/date).
This further certifies that the arrested suspect/s have been examined by
Dr. _________________________ on ________________ at ___________________.
Rank/Name/Signature of Duty Investigator Rank/Name/Signature of Arresting Officer

_______________________________ ______________________________
_______________________________ _____________________________
Received By:
_______________________________
Rank/Name/Signature of Duty Jailer
Time/Date: _________________
(16) Sample Format of Crime Report

(The Command)
(Group, District or Unit)
Case Report No. _________________ Date _________
CRIME REPORT
NATURE OF CASE : __________________________________________

COMPLAINANT/VICTIM : __________________________________________
(NAMES AND PERSONAL
CIRCUMSTANCES OF VICTIMS)
___________________________________________
(IN RAPE CASES, ENCLOSE THE MEDICAL
FINDING)
DATE/TIME/PLACE : __________________________________________
OF OCCURRENCE : __________________________________________
SUSPECTS : __________________________________________
(NAMES PERSONAL
CIRCUMSTANCES, ADDRESSES,
:
___________________________________________
IF KNOWN AND PHYSICAL DESCRIPTION
IF AT LARGE)
EVIDENCES : __________________________________________
WITNESSES : __________________________________________
(NAMES AND ADDRESSES)
FACTS OF THE CASE :
NAME OF OFFICER-ON-CASE
RANK PNP DESIGNATION
NOTED AND FORWARDED:

CHIEF/HEAD OF GROUP/UNIT
RANK PNP DESIGNATION
(17) Sample Format of Situation Report
(Sample)
(Name of Medical Center)

Situation Report (SITREP)
Numbered Sequentially, Report No. ______

Date of Report _______
(Event – Brief Description: e.g. “Facility Fire”)
I. Background and Current Situation: (Give brief background of the event and
situation update from the last SITREP.)
Example: “On November 12, 2001, a structural fire resulted in damage to the
nursing home facility (Building 4301) causing the evacuation and relocation of
52 patients. Patients were evacuated without incident and are temporarily being
provided care and housed in the main hospital building. Most of the damage
was resulted from smoke and water. Investigation completed yesterday has
determined that the cause of the fire was careless use and disposal of smoking
materials by a painting contractor working in the nursing home facility.
II. Operations Status/Update: (Provide overall status by color code: Green,

Yellow, Red or Black; followed by narrative providing specifics relating to the
response to the event; and if applicable, information relating to effects to attain
full operational status with an estimated date.)
Example: Facility Status “Red”
1. Nursing home admissions curtailed pending clean up and repair of building
4301. Estimated completion date is November 19, 2001. In the interim
admissions are being referred to our contract facility.
2. VA Police have cited contractor employee for smoking in a restricted area.

Regional General Counsel’s Officer reviewing whether further actions are
warranted against the individual and/or contractor.
3. Estimated damages are $155,000.
III. Point(s) of Contact: (List name, phone, cell phone, fax and pager numbers of
individual(s) who should be contacted if additional information is desired.)
_________________________________________ _____________________
(Signature of Medical Center Director or Designee) Date
(18) SAMPLE INCIDENT REPORT FORM

INCIDENT REPORT FORM*
To be completed by activity organizers/walk leaders as soon as practical after the

incident. This report should be kept by the club secretary as a formal club record. In the
event of any serious injury (an injury requiring medical treatment) copies of the incident
report must be forwarded to the Insurance Convener for the State of the Member Club.
Report prepared by: Date prepared:
Contact details: Club name and address:
Date of Incident: Time of Incident:
Type of Event: Day walk, canoe trip, bike ride etc..
Location:
Type of Incident: Injury, missing person, damage to property, theft, fire, etc..
Incident Details:
Action Taken:
External Involvement: Were authorities or other agencies notified at the time? If so

who, by whom, and how? Did they then take a role in managing the incident? If
appropriate have the Insurers been notified?
Final Outcome: What was the final outcome of the Incident? When was it resolved?
Future Prevention: Can this incident be prevented at future Club activities? If so,
how?
Supplementary Information: This section can include a list of attachments, such as

a map, witness statements etc..
Privacy Note
The inclusion of the names of individuals and their contact details in this report must be
done in accordance with relevant Privacy laws
(19) Sample Format of Miscellaneous Incident Report
MI REPORT
FROM: __________________________ TO: _______________________

WHAT: __________________________ WHEN: ____________________
WHERE: ____________________________________________________
WHO: (NAME OF VICTIM/S) ____________________________________
NAME OF SUSPECT/S: _______________________________________
HOW:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
CASUALTIES:
CRIMINAL SIDE:
_____________________________
GOVERNMENT SIDE:
_________________________
CIVILIAN:
___________________________________
REMARKS: _________________________________________________
_________________________________
(Name of Officer on Case)
Certified Correct by: __________________________________________

Desk Officer: ________________________________________________
(20) Sample Format of a Traffic Accident Investigation Report
PC/INP Form _____________________ File NR …….

_____________________
TRAFFIC ACCIDENT INVESTIGATION REPORT
WHERE
………………………………………………………………………………
(Near/Km Post Nr) (Near Intersection/Landmark)
………………………………………………………………………………
(Hwy/St/Rd) (Dist/Bo) (Mun/City) (Prov)
WHEN
………………………………………………………………………………
(Day of week) (Date) (Time)
WHAT
Vehicle vs. 1. Another Vehicle 5. Bicycle 9. Animal-
drawn vehicle
2. Pedestrian 6. Scooter 10. Fixed
Object
3. Animal 7. Railroad train 11. Non-
collision
4. Motorcycle 8. Push Cart
TYPE OF ACCIDENT: 1. Fatal 2. Non-Fatal 3. Property damage
HOW:
Head-on 4. Sideswipe-same direction Width of road…...m/ft ………
Rear-end 5. Sideswipe-opposite direction Width of shoulder m/ft…..….
Angle 6. Others (specify) Number of lanes ………..….
VEHICLE Number of Vehicles Involved

(Use
supplemental TAIR if more than two vehicles)
Vehicle 1 Vehicle 2
TYPE ………………………..…..…. …………………..……………
Make and Model …………..……… …………..……………………
Plt. Nr. Decal Nr. …………..……… …………..…………………..
Classification & Place of Issue ….. …………..…………………..
Driven by …………..………………. …………..…………………..
Address …………..………………… …………..…………………..
Occupation …………..……………. …………..…………………..
Driver’s Lic. Nr …………..……….. …………..…………………..
Nationality …………..……………. …………..…………………..
Age …………..…………………..…. …………..…………………..
Sex and Status …………..…………… …………..…………………..
Driving experience …………..………… …………..…………………..
Vehicle owner …………..……………… …………..…………………..
Address …………..…………………..… …………..…………………..
Reg. Cert. Nr. & File Nr …………..…… …………..…………………..
Estimate Damage …………..………… …………..…………………..
VI. WHAT DRIVERS WERE DOING:

2 (Check appropriately) 1 2
Going straight 10. Backing
Turning right 11. Evading vehicle
Turning left 12. Evading pedestrian
Making U-turn 13. Evading animal
Slowing 14. Evading object
Abrupt stopping 15. Overtaking
Stopped 16. Parked
Entering parked position 17. Others (specify)
…………
Leaving parked position
VII. WHAT PEDESTRIANS OR ANIMALS ARE DOING:

Crossing between intersection 11. Along roadway outside
sidewalk
Crossing at intersection 12. Along roadway without
sidewalk
Crossing upon signal 13. Standing in safety
zone/island
Crossing against signal 14. Getting on vehicle
No signal 15. Getting off vehicle
Crossing at pedestrian lane 16. Evading other vehicle
Crossing without pedestrian lane 17. Pushing cart/wagon
Coming from behind moving vehicle 18. Pulling cart/wagon
Coming from parked vehicle 19. Vending on road
Along roadway on sidewalk 20. Others (specify) ………
VIII. CONDITION OF MOTOR VEHICLE
1 2 1 2
No defects noted 9. Tail lights out
Brakes defective 10. Brake lights defective
Headlights glaring 11. Signal lights defective
Both headlights insufficient 12. Steering mechanism
defective
Both headlights out 13. Windshield wipers
defective
One headlight insufficient 14. Defective tires
One headlight out 15. Others (specify) ……….
Tail light/s insufficient
IX. VIOLATIONS INDICATED

1 2 1 2
Disregarding traffic signs and signal 9. Wrong side of road
Weaving in-and-out of traffic 10. No right of way
Exceeding lawful speed 11. Dangerously loaded
Unsafe passing between intersections 12. Under the influence of intoxicants
Unsafe passing in hill/curve 13. No valid driver’s license
Operating defective vehicle 14. No driver’s license
Failure to signal 15. Others (specify) …………
Hit-and-run
X. CONDITION OF DRIVER OR PEDESTRIAN:

Absolutely normal 5. Had been drinking liquor
Physical defects (eyesight…..) 6. Was absolutely drunk
Sick or ill 7. Others (specify) …….
Apparently sleepy
XI. VISION OBSCURED BY:

1 2
Trees, plants, crops, etc. 6. Moving vehicle
Building, house, fence, etc. 7. Its own cargo
Hillcrest, embankment 8. Rain
Signboards 9. Falling objects
Parked vehicles 10. Others (specify) ……
XII. ROAD CHARACTER, SURFACE:
Straight road 1. Concrete
Curve 2. Asphalt
Level road 3. Gravel
Dip 4. Sand
Hillcrest 5. Earth
Upgrade 6. Coral
Downgrade
XIII. ROAD CONDITION, WIDTH, LANES:

No defects noted 1. Dry
Lanes marked 2. Wet
Defective shoulder 3. Muddy
Loose material 4. Dusty
Holes, deep ruts 5. Under construction
Lines separated 6. Other (specify)
XIV. WEATHER CONDITION, DAYLIGHT CONDITION

Fair 1. Sunny
Cloudy 2. Dim (cloudy)
Foggy 3. Dark-moonlight
Stormy 4. Dark-artificial light good
Rainy 5. Dark-artificial light poor
Smoky 6. Darkness
Windy
XV. POINT OF IMPACT:

1 2
Front end 7. Front left side
Right front 8. Center left side
Left front 9. Rear left side
Front right side 10. Rear end
Center right side 11. Right rear
Rear right side 12. Left rear
XVI. SKETCH OF ACCIDENT :
(Use separate sheet if necessary and indicate File Number)

INSTRUCTIONS:
1. Number each vehicle and show 3. Show pedestrians or animals by
the direction of travel by arrow. _____________
_______________
2. Use solid line to show direction before impact. Show North by Arrow.
-------------------------- _____________
Dotted lines after impact ………………. 4. Draw out roadway in solid lines
Conforme: Driver vehicle 1 ……………………….. Vehicle 2 ………………..………
XVII. BRIEF NARRATION:
XVIII. CASUALTY LIST:

Legend: K-killed; SI-Serious Injury; SPI-Slight Physical Injury; D-Driver;
Pd-Pedestrian; Ps-Passenger
NAME SYMBOL ADDRESS AGE SEX HOSPITAL

TAKEN
……………….. ………… ………………… …….. ……… ………………….
……………….. ………… ………………… …….. ……… ………………….
……………….. ………… ………………… …….. ……… ………………….
XIX. WITNESSES NAME ADDRESS
………………..…………………………………..…………………………………….……….
………………..………………………………….………………………………………….….
XX. ACTION TAKEN: ….……………………….………………………………………….….
XXI. RECOMMENDATION: ….…………….………………………………………….….
XXII. STATUS OF CASE: ….……………………….……………………………………
XXIII. REPORTED BY: ….……………………….………………………………………
XXIV. INSURANCE COVERAGE DATA: Vehicle 1 Vehicle 2

Insurance Company and Police Nr. And Sticker Nr. ….……………………….…………….
….………………………………………………..….……………………….……………………
Certificate of Cover Nr. ….……………………….……………………………………..
Date Issued/Period Covered ….……………………….………………………………
XXV. ENCLOSURES ….……………………….…………………………………………….
XXVI. INVESTIGATED OR PREPARED BY: ….………………………….…………………

(Office) (Print name and sign)
(21) Actual Sample of Police Report on Vehicular Accident with Physical Injury

MANDAUE CITY POLICE OFFICE
Traffic management unit
Andres Soriano Avenue, Brgy. Centro, Mandaue City
Tel no. 344-7751/ e-mail: tmu_mcpo@yahoo.com. Website: www.pnp-mcpo.com
TRAFF -1
POLICE REPORT
TO WHOM IT MAY CONCERN:
THIS IS TO CERTIFY that an entry no.138 found on page no. 65 of Traffic Book
of Events volume 125-A series of 2012 to wit:
VEHICULAR ACCIDENT with PHYSICAL INJURY
PLACE : P. Burgos St., Alang-Alang, Mandaue City

T/D : 09:15 A.M., August 01, 2012
DS/VS INVOLVED
A. Kia Wagon with Plate# JCL-465, driven by __________________ 50 years old
of Sinco Cmpd. Alang-Alang, Mandaue City with license# GO1-92-148092.
Reg. Owner: __________________ of 386 Lapu-Lapu City
Contact #s: ___________________________
B. Honda Motorcycle with plate# 9086-YD, ________________ 20 years old of

Zone # Camino Road, Canduman, Mandaue City with license # G05-10-
005296.
Reg. Owner: __________________ of Deca Prime, Jagobiao, Mandaue City
Contact #s: ___________________________
O/case: PO1 Dejeto, MJ

FACTS
Initial investigation conducted disclosed that on above cited time, date and place,
vehicle A was executing left turn when it was hit by vehicle B which was travelling B.
Burgos Street bound to Opao, Mandaue City. As a result thereof, vehicle A incurred
damage on its left side passenger door portion while vehicle B incurred damage on its
front wheel rim and left side portion and driver of vehicle B sustained injury.
REMARKS: 10:40 A.M., August 01, 2012. It appears in the investigation conducted by
the officer-on-case (PO1 Dejeto, MJ), that driver of vehicle B is the party at fault for hitting
the left side of vehicle A.
NOTE: Driver of vehicle B was advised to undergo medical check-up
ACTION TAKEN: Driver of Vehicle B was issued T.O.P.
This certification is being issued upon request of the party concern for whatever
legal purpose this may serve best.
Issued this 7th day of August 2012 at Mandaue City, Phils.
Prepared by: Verified by:
STELLA MARIE S. SUICO SPO4 APOLINARIO J NEIS

Encoder Chief, Investigator
O.R. no. 0289210 Noted by:

Mandaue City
08/07/2012 PCI JIMMY L AGUISANDA
Php 11.00 Chief, TMU
VEHICULAR ACCIDENT
Plate Number A. ___JCL – 465______ B. ____9086 – YD_______

Make and Model A. _KIA WAGON______ B. HONDA MOTORCYCLE
Registration Number A. 216846442 05/14/2012 B. _247908743 07/11/2012_
Name of driver A. _________________ B. ____________________
Age A. ___50 YRS. OLD___ B. ___20 YRS. OLD______
Driver’s Address/Present A. _ALANG-ALANG MC B. _CANDUMAN MC_____
Driver’s Prov. Address A. _________________ B. ____________________
License Number A. GOI-92-148-092____ B. __GO5-10-505296____
Operator/Owner A. _________________ B. ____________________
Address A. 386 LAPU-LAPUCITY B. JAGOBIA, MC_________
Name of Insurance A. _________________ B. ____________________
Place of Accident A. P. Burgos St., Alang-Alang, Mandaue City________
Tel. Number A. _________________ B. ___________________
______Initial investigation conducted disclosed that on above cited time, date and place,
vehicle A was executing left turn when it was hit by vehicle B which was travelling B.
Burgos Street bound to Opao, Mandaue City._______________________
______As a result thereof, vehicle A incurred damage on its left side passenger door
portion while vehicle B incurred damage on its front wheel rim and left side portion and
driver of vehicle B sustained injury._________________________________________
_____________________________________________________________________
REMARKS / FINDINGS
10:40 A.M., August 01, 2012. It appears in the investigation conducted by the officer on
case PO1 Dejeto, MJ; that driver of vehicle B is the party at fault for hitting the left side
of vehicle A.___________________________________________________________
____________________________________________________________________
AT. Driver of vehicle B was issued T.O.P____________________________________
(22) Sample Format of Investigation Data Form

Department of Justice
Office of the City Prosecutor
Lapu-lapu City
INVESTIGATION DATA FORM
To be accomplished by the Office:
DATE RECEIVED: NPS DOCKET NO. _______
(stamped and initialed): ___________________ ___________________________

Time Received: _________________________ Assigned to: _________________
Receiving Staff: _________________________ Date assigned: _______________
____________________________________________________________________
To be accomplished by the complainants/counsel/law enforcer;

(use back portion of space is not sufficient)
COMPLAINANT/S: Name, Sex, Age & Address RESPONDENT/S: Name, Sex, Age & Address
OFFENSE/s COMMITTED/LAW/s VIOLATED: WITNESS/ES: Name & Address
DATE & TIME of COMMISSION: PLACE of COMMISSION:
1. Has a similar complaint been filed before any other office? NO _____
2. Is this complaint a nature of counter charge? NO _____ If yes, indicate details below.
3. Is this complaint related to another case before this office? NO _____ If yes, indicate details below.
NPS Docket No. _________

Handling Prosecutor ______
CERTIFICATION
I 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 that a similar
action has been filed and/or is pending. I shall report that fact to this Honorable Office within five (5)
days from knowledge thereof.
SUBSCRIBED AND SWORN TO before me this ___ day of ________ in Lapu-lapu City, Philippines.
_________________________
Prosecutor Administering Oath
(23) Sample Request for Preliminary Investigation and Waiver of Article 125,
Revised Penal Code (NPS Form 3)

OF __________
________________,
Complainant,
-versus- I.S. No. _________
________________, FOR: ___________
Respondent.
X________________x
REQUEST FOR PRELIMINARY INVESTIGATION AND WAIVER OF

ARTICLE 125, REVISED PENAL CODE
I wish to avail myself of my right to a preliminary investigation and, for this

purpose, I hereby voluntarily waive my rights under the provisions of Article 125
of the Revised Penal Code. Pending the completion of the preliminary
investigation proceedings, I agree to remain under police custody.
_______________________, Philippines, _____________________

(Place) (Date)
________________________
Respondent
Assisted by:
_________________________
Counsel/responsible person
Certification
(For Information in Inquest Cases)
I hereby certify that the foregoing Information is filed pursuant to Section 7,

Rule 112 of the 1985 Rules on Criminal Procedure, as amended, the accused not
having opted to avail of his right to preliminary investigation and not having
executed waiver pursuant to Article 125 of the Revised Penal Code. I further certify
that this information is being filed with the prior authority of the City/Provincial
Prosecutor.
__________________________
Inquest Officer
(24) Sample of Memo for Preliminary Investigation

OFFICE OF THE CITY PROSECUTOR
Manila
Related to: _______________ I.S. No. _____________

I.S. No. _______________ Prosecutor _____________
Prosecutor _______________ Date Filed _____________
MEMO OF PRELIMINARY INVESTIGATION
COMPLAINANT/S: RESPONDENT/S
1. _____________________________ 1. ____________________________
Address: _______________________ Address: ______________________
2. _____________________________ 2. ____________________________
_____________________________ ____________________________
3. _____________________________ 3. ____________________________
_____________________________ ____________________________
CHARGE: 4. ____________________________
___________________________________________________________________
Place of Commission 5. ________________________________
__________________________________________________________________
Date ______________ Time ________________ (Use back hereof for add, accused)
Witness:
Name ________________________ Address _______________________
_____________________________ ______________________________
_____________________________ ______________________________
NOTE: 1. Has a similar complaint been filed before any other office? (YES OR NO)
2. Is this complaint in the manner of a counter-affidavit? ___ (YES OR NO)
3. Are all the above information true and correct _________ (YES OR NO)
THE ABOVE SHOULD BE FILLED UP BY COMPLAINANT OR COUNSEL
Investigation on ____________________ Postpone to ___________________

On relation of ______________________________
______________________________
(Signature of complainant or counsel)
TAKE NOTE: Sufficient copies of the affidavit *************************************

Of complainant and witnesses and other ACTION TAKEN:
Supporting document should be submitted.
_______________________________
Investigation Prosecutor
IMPORTANT!
A complaint shall be required to file his complaint in the form of an affidavit to which
must be appended affidavit of witnesses, annexes and other supporting documents. The
statements of the complainant and his witnesses, shall be, far as practicable, be sworn
to before the investigating Prosecutor. If sworn before any Office authorized to
administer oaths, the administering Office shall CERTIFY THAT HE HAS PERSONALLY
EXAMINED THE AFFIANT AND THAT HE VOLUNTARILY EXECUTED AND
UNDERSTOOD HIS AFFIDAVIT.
Late resolution given to Stenographer __________________________
___________________________ ____________________________
Investigating Prosecutor Stenographer
(25) Sample Format of Initial Investigation Report

______________________________________
____________________________
MEMORANDUM
FOR :
FROM :
SUBJECT : Investigation Report on ______________
DATE :
I. AUTHORITY
1. Memo from that Office dated _________ re-investigation report on the above
subject.
2. Inherent
II. MATTERS TO BE INVESTIGATED

3. To determine the surrounding circumstances of the killing of the said police
officer.
4. To possibly identify the suspects that will led to their apprehension and
possible prosecution
III. FACTS OF THE CASE

5. (D/T/P Occurrence and events)
IV. INVESTIGATION/FINDINGS
6. Etc.
V. CONCLUSION
VI. RECOMMENDATION/DISPOSITION
_________________
Chief of Office
(26) Sample Format of Progress Report

(The Command)
MEMORANDUM
FOR :
FROM :
SUBJECT : PROGRESS REPORT
DATE :
Reference: (previous related Memo)
(Indicate briefly the date/time and place of

occurrence)
(Brief facts of the case)
(Other facts)
Requested/recommended actions from

Hqs.
Disposition/Action Taken
Final Report will follow
_______________________
INVESTIGATING OFFICER
(27) Sample Format of Final Report

(The Command)
MEMORANDUM
FOR :
FROM :
SUBJECT : FINAL REPORT
DATE :
Reference: (previous related Memo)
(Indicate briefly the date/time and place of

occurrence)
Background/Brief of facts of the case
Sequence of Events
Summary of Action
Recommendation/Conclusion
Disposition/findings
For your information
_______________________
INVESTIGATING OFFICER
Below is a sample format of a Police Blotter page:
ENTRY NO. DATE TIME EVENT/INCIDENTS DISPOSITION

[ For “Actual Sample of Incident Record Form (IRF) visit the link below
http://www.didm.pnp.gov.ph./images/Incident%20Record%20Forms/Incident%20Recor
d%20Form.pdf ]
Sample of Incident Record Form (IRF)
FOR POLICE BLOTTER ENCODER USE

ONLY
BLOTTER ENTRY NUMBER Philippine National Police
INCIDENT RECORD FORM
TYPE OF INCIDENT
INSTRUCTIONS: Refer to PNP SOP on ‘Recording on Incidents in the Police Blotter’ in filling up this form.
This Incident Record Form (IRF) may be produced, photocopied, and/or download from the DIDM website,
www.didm.pnp.gov.ph.
DATE AND TIME DATE AND TIME OF
REPORTED: INCIDENT: ITEM “A” – REPORTING PERSON
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
CITIZENSHIP SEX/GENDER CIVIL DATE OF AGE PLACE HOME MOBILE

STATUS BIRTH OF PHONE PHONE
(DD/MM/YY) BIRTH
CURRENT ADDRESS (HOUSE VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

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

NUMBERS/STREET)
HIGHEST EDUCATIONAL OCCUPATION ID CARD EMAIL ADDRESS (IF

ATTAINMENT PRESENTED ANY)
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

STATUS BIRTH OF BIRTH PHONE PHONE
(DD/MM/YY)
NUMBERS/STREET)

NUMBERS/STREET)
HIGHEST EDUCATIONAL OCCUPATION WORK RELATION TO EMAIL ADDRESS
ATTAINMENT ADDRESS VICTIM (IF ANY)
IF AFP/PNP UNIT GROUP WITH PREVIOUS CRIMINAL Status of

PERSONNEL: ASSIGNMENT AFFILIATION RECORD? [ ] YES [ ] NO previous case
RANK (If Yes, Pls. Specify)
HEIGHT WEIGHT COLOR DESCRIPTION COLOR DESCRIPTION UNDER THE

OF EYES OF EYES OF OF HAIR INFLUENCE?
HAIR NO DRUGS
LIQUOR
OTHERS
______________
FOR CHILDREN IN CONFLICT WITH THE LAW

NAME OF GUARDIAN ADDRESS HOME PHONE MOBILE PHONE
GUARDIAN
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
INCIDENT RECORD TRANSACTION RECEIPT
NUMBER
THIS CERTIFIES NAME OF REPORTING PERSON: ADDRESS OF REPORTING PERSON:
THAT
TYPE OF INCIDENT:
REPORTED AN
INCIDENT TO BE
RECORDED IN THE
AND
POLICE BLOTTER
RECORDED
WHICH INVOLVES
BY:
DATE/TIME OF DATE/TIME OF PLACE OF

REPORT: INCIDENT: INCIDENT : 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 NICKNA
ME
STATUS BIRTH OF PHONE PHONE
(DD/MM/YY) BIRTH

NUMBERS/STREET)
NUMBERS/STREET)
HIGHEST EDUCATIONAL OCCUPATION WORK ADDRESS EMAIL ADDRESS (IF
ATTAINMENT ANY)
ITEM “D” – NARRATIVE OF INCIDENT

BLOTTER ENTRY TYPE OF TIME DATE PLACE OF INCIDENT
INCIDENT
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)
(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 NAME/SIGNATURE OF
FOREGOING TO THE BEST OF MY KNOWLEDGE AND REPORTING PERSON DESK OFFICER
BELIEF.
CASE DISPOSITION (For Chief/Head of Office Use Only)
CHIEF Of STATION/OFFICE NAME OF DESIGNATED NAME OF CHIEF OF
INSTRUCTIONS INVESTIGATOR-ON-CASE STATION/OFFICE
-----------------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 Telephone

Investigator-on-case Mobile phone
Name of Chief/Head of Officer Mobile phone

(1) Sample form of Summons from the Clerk of Court:

MUNICIPAL TRIAL COURT
BRANCH 3
MANDAUE CITY
_____________________
Plaintiff CIVIL CASE NO. 6330
--versus-- FOR: COLLECTION OF
UM OF MONEY
ATTY’S FEE
______________________
Defendant (s)
x-----------------------------------/
SUMMONS
TO:
You are hereby informed that the Rules on Summary Procedure shall apply in
the above-entitled case. Thus, you are hereby required to answer the complaint duly
served upon you within TEN (10) DAYS FROM SERVICE thereof. Should you fall to
answer the complaint within the reglementary period stated herein, the Court will
enter judgment against you by default and grant the demand or relief applied for in
said complaint.
Witness the Honorable _______________, Presiding Judge of this Court, this
____________, day of ________ 20_____.
__________________
Clerk of Court
(2) Sample form of Summons from PLEB:
Province of _________
PEOPLE’S LAW ENFORMENT BOARD
________________________________
(City/Municipality)
________________ Adm. Case No. __________

Complainant,
-versus-
________________ For: __________________
Respondent (s) (Offense charged)
SUMMONS
TO: _______________
_______________
GREETINGS:
You are hereby notified that a formal administrative complaint against you, copy
attached, has been filed with this Office for the afore cited offense under the provision of
Section 41 of Republic Act No. 6975 (“Department of the Interior and Local Government
Act of 1990”) in relation to NAPOLCOM Memorandum Circular No. _________ dated
_________ 1991.
Wherefore, you are hereby required to answer in writing the abovementioned
charge(s) within five (5) days from receipt hereof, and to file said Answer under oath in
three (3) copies to the Board. Attach herewith such documentary evidences as you wish
to present in your defense.
Given this ____ day of _____________, 20 ____ at __________, Philippines.
____________________________
Chairman
People’s Law Enforcement Board
The Chief of Police

____________________
Sir:
Please give due course to the herein summons and to return to this office the
original of the same with your proof of service indorsed at the back hereof.
Very truly yours,

___________________________
(3) Sample form of Answer from PLEB

Province of ___________
PEOPLE’S LAW ENFORCEMENT BOARD
(City/Municipality)
The Chairman _____________

People’s law Enforcement Board Date
___________________________
ANSWER
Sir:
I, ___(Name of Respondent)__, now a _(State Rank)_ in the police station of

______(City/Municipality/Province)___ after having been furnished a copy of the
charge (s) filed against me.
In support thereof, I wish to state that I deny the allegations in Paragraph 1, etc.,
the truth of the matter being ____(State briefly the detail of the defense, attaching of
all evidence available at the time of answer)________________ .
In the formal investigation of the above mentioned charge (s) against me, it is
requested that the following witnesses in my favor be called upon to testify thereat
and/or that the following documents be required to be brought by __(State name and
address of witness and the documents to be passed)__ before that Board as evidence
for my defense.
In witness hereof, I hereunto sign my name this ______ day of __________ 20

_______ In _(Place of Investigation)___, Philippines.
___________________
(Name of Respondent)
SUBSCRIBE AND SWORN to before me this _______ day of __________ 20

_______, in the City/Municipality of _____________, affiant exhibiting to me his/her
Residence Certificate No. A-________________ issued at ____________________
On ______________________ 20_______.
___________________________
(Person authorized to administer
an oath; or Chairman of PLEB)
(4) Sample form of Certificate of Appearance from Clerk of Court:

REGIONAL TRIAL COURT
7th Judicial
Branch 56
Mandaue City
CERTIFICATE OF APPEARANCE
This is to certify that ___________________________, appeared at this Branch of

the Regional Trial Court, Branch 56, Mandaue City in the morning/afternoon of
______________________, _______________ in connection with the hearing of
civil/LRC Case/Sp Proceeding/ Criminal Case No. DU-______________, MAN-
___________________ Plaintiff versus __________________________
(accused/Defendants/Petitioner/Applicant) now pending with this Court.
Mandaue City, Philippines, ______________________, __________________.
___________________
Branch Clerk of Court
(5) Sample form of Subpoena from Clerk of Court

7th Judicial
Branch 56
Mandaue City
PEOPLE OF THE PHILIPPINES

Plaintiff CRIM CASE: 355829
-versus-
FOR: THEFT
________________________,
Accused
x------------------------------------------------/
SUBPOENA
TO:
GREETINGS:
You are hereby commanded to appear before this Court on the 8th of May
2011 at 8:00 in the morning then and here to testify in the above entitled case
(s).
Fail not, under the penalty of the law.
WITNESS the HON ___________________, Judge of this Court, this 10th

day of April 2011.
____________________
Branch Clerk of Court
Served by: ________________

(6) Sample form of Subpoena from PLEB:

Province of _____________
PEOPLE’S LAW ENFORCEMENT BOARD
__________________________________
(City/Municipality)
________________ Adm. Case No.

________________
Complainant,
-versus-
_________________ For:
_________________
Respondent (s) (Offense charged)
SUBPOENA
TO: _______________
_______________
GREETINGS:
You are hereby required to appear and be present at the hearing of the
abovementioned case before this Board at __________ a.m./p.m. on the
______ day of ___________ 20 ______, then and there to testify in the above
cited case pending therein.
FAIL NOT UNDER THE PENALTY OF THE LAW

Given this _____ day of __________ 20_____ at _______________
_______________________.
______________
Chairman
PROOF OF SERVICE
I have this day served a copy of the foregoing subpoena upon Mr.
____________ Personally (or by Registered mail no. _____________)
Date this _____________ day of ________________, 20 ______.
___________________
Serving Party
(7) Actual Sample of Subpoena

MUNICIPAL TRIAL COURT IN CITIES
7th Judicial Region
BRANCH 01
Cebu City
PEOPLE OF THE PHILIPPINES,

Plaintiff,
CRIM. CASE NO. 100070-R
-versus-
_________________________ FOR: RECKLESS IMPRUDENCE
RESULTING IN HOMICIDE
Accused.
x-------------------------------------------/
SUBPOENA
MIC-1879 11/24/09
TO SPO1 EUGENIO RAGANAS, JR.
c/o Traffic Group, CITOM BUILDING
N. Bacalso Avenue, Cebu City.
Greetings:
You are hereby commanded to be at and appear in the FIRST BRANCH of the
Municipal Trial Court, Cebu City on February 8, 2010 at 8:30 o’clock in the morning,
then and there to testify in connection with the above-entitled case.
FAIL NOT UNDER THE PENALTY OF THE LAW.
Witness the HON. MONALILA S. TECSON Judge of this Court this 18th day of
November, 2009.
CLARINA N. VILLARUEL
(OIC) Branch Clerk of Court
(8) Sample Order (NPS Form 1)

OF ____________
____________________,
Complainant,
-versus- I.S. No. ___________
FOR: _____________
____________________,
Respondent.
X_____________________x
ORDER
(To submit additional evidence/documents)
__________
__________
_________
In connection with the investigation being conducted in the above-

captioned case, you are hereby directed to submit the following
evidences/documents, to wit:
_______________________________________
_______________________________________
_______________________________________
_______________________________________
Within_____ hours from receipt hereof; otherwise, the undersigned shall order
the release of the above-named respondent, and this case shall (1) have to be
filed with this Officer for regular preliminary investigation or (2) be treated as filed
for regular preliminary investigation.
_________________________, Philippines. __________________ 20_____.
________________________
Inquest
Received copy this ________ day of __________________ 20_____.

Copy received by: ________________________________________
Investigating/Police Officer
(9) Sample form of Petition for the Issuance of Arrest/Search Warrant
People of the Philippines, Plaintiff

Versus
A.B., Accused.
Criminal Case No.__________

For (state nature the offense)
The undersigned (name of applicant) after having been duly sworn, states:
That (name of the person to be searched), who may be found at

(describe premises) is in possession or has in his control (name property
subject of the offense; or stolen or embezzled and or other proceeds or
fruits of the offense; or used or intended to be used as the means of
committing an offense) which he is keeping and concealing in premises
above described. (Cancel description not applicable.)
That a search should be issued to enable any agent of the law to take
possession and bring to this court, the following described property: (give
complete and detailed description of the property to be seized).
Wherefore, the undersigned prays this honorable court to issue a

search warrant authorizing any agent of the law to search the premises above
described and to seize and surrender to this Honorable Court the personal
property mentioned above to be dealt with as the law directs.
_____________________________________, Philippines
_____________________ 20 ____________
____________
Applicant
(10) Sample form of Warrant of Arrest
Plaintiff,
Vs.
B.,
Accused,
Criminal Case No. ________________
For: (State Nature of the Offense)
TO ANY OFFICER OF THE LAW:
You are hereby commanded to arrest _______________ who is said to

be found at __________________ or elsewhere and who has been charged
before me with the offense of ______________ and bring his/her forthwith
before me to be dealt with according to the law.
The bail for the release of the accused in this case is fixed at
_______________, which may be furnished by the accused either by depositing
the amount thereof with the nearest collector of Internal Revenue or Provincial
City or Municipal treasurer who should transmit to this court the same, or by
furnishing a personal bail bond subscribed by two or more solvent sureties
whose solvency may be shown by their land tax receipt and certificates of title
free from encumbrances and determined by any Judge of Regional Trial Court,
who may accept the bail and transmit the same to this Court. The peace officer
making the arrest is hereby authorized to discharge from custody the accused
after furnishing bail in the manner herein above indicated which must be stated
in the return hereof.
Quezon City, _________________________ 20_________
_______________
Judge
1st Endorsement
____________________ 20 ___________
Respectfully referred to the Station Commander _______________

the Director NBI Manila and the Chief PNP, Camp Crame, Quezon City
for the execution of the warrant within ten (10) days from the receipt
hereof, and to make a return to this Court within ten (10) days after the
expiration of such period (Sec. 4 Rule 113, 1985 of Criminal Procedure)
Copy furnished:
NBI Manila
Chief, PNP Camp Crame
Station Commander
________________________
BRANCH CLERK OF COURT
(11) Sample of Warrant of Arrest

7th Judicial Court
Branch 09
Lapu-lapu CIty
THE PEOPLE OF THE

PHILIPPINES.
Plaintiff CRIMINAL CASE NO. 889A-58
versus For
_____________________
Accused
ALIAS
ORDER OF ARREST
TO ANY OFFICER OF THE LAW

Thru THE CHIEF OF POLICE
PNP Lapu-lapu Police Office
Lapu-Lapu City Cebu
You are hereby commanded to arrest ____________________ who was said to

found at Gun-ob Lapu-lapu City, Cebu or elsewhere and who has been charge before
me with the case of ______________________ and bring his/her forthwith before me to
be dealt with according to law.
The bail for the release of the accused in this case is fixed at _No Bail_, which may
be furnished by the accused either, by depositing the amount thereof with the nearest
collector of Internal Revenue or Provincial. City or Municipal treasurer who should
transmit to this court the same, or by furnishing a personal bail bond subscribed by two
or more solvent sureties whose solvency may be shown by their land tax receipt and
certificates of the title free from encumbrances and determined by any judge of Regional
Trial Court, who may accept the bail and transmit the same to this Court. The peace
officer making the arrest is hereby authorized to discharge from custody the accused
after furnishing bail in the manner herein above indicate which must be stated in the
return hereof.
25th _ Day of ___ January_ 2010 at ___ Lapu-lapu City, Cebu, Philippines_.
Federico I. Balbon
Judge
Note:
The arresting officer as hereby directed to return this Order of Arrest within a period
of _____ days upon receipt, together with the endorsement of action taken hereon.
(12) Sample form of Search Warrant Issued by the Court:
Form 26 ________ Search Warrant

Plaintiff, Criminal Case No. ___________
Vs. For: (State Nature of the Offense)
A. B.,
Accused,
To Any Peace Officer:
Greetings:
It appearing to the satisfaction of the undersigned after examining under

oath (name of applicant) and his witness (name of witness) that there is probable
cause to believe that (describe the act charged) has been committed or is about
to be committed and that there are good and sufficient reasons to believe that
(name of person, or persons to be searched) has in his possession or control in
(describe the premises) in (name of street), district of _________, (name of
property subject of the offense; or stolen or embezzled and other proceeds or
fruits of the offense; or used or intended to be used as the means of committing
an offense) which should be seized and brought to the undersigned. (Cancel
description not applicable).
You are hereby commanded to make an immediate search at any time in
the day (or night) of the premises above described and forthwith seize and take
possessions of the following personal property, to wit: (give a complete and
detailed description of the property to be seized) and bring said property to the
undersigned to be dealt with as the law directs.
Witness my hand this _________ day of _____________, 20_____.
____________
Judge
(13) Sample Format of Certification of Legally, Peacefully and Orderly Execution
of Search Warrant

___________________________________
______________________
CERTIFICATION OF LEGALLY, PEACEFULLY AND ORDERLY EXECUTION

OF SEARCH WARRANT:
THIS IS TO CERTIFY that elements of __________________ stationed at Camp

Crame, Quezon City, have today ___________, 20___ conducted Search and Seizure
in my residence/premises located at ________________________, _______ by virtue
of Search Warrant No. ______ issued by Honorable Judge ______________,
Executive/Presiding Judge of Branch ______, RTC, __________ dated ___________:
That during the course of their search, they found and recovered the following
personal properties of mine which is the subject of the Search Warrant, to wit;
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
I FURTHER CERTIFY that the search was done in peaceful, appropriate and
orderly manner and nothing were taken by the searching party aside from those
enumerated above.
________________________________
(Signature over printed name of owner)
SIGNED IN THE PRESENCE OF:
1.) ____________________________ 2.) ___________________________

(Signature over printed name) (Signature over printed name)
SEARCHING PARTY/TEAM LEADER:
_________________________________
SUBSCRIBED AND SWORN to before me this ______ day of _____________

20_______ at ____________________________, __________________________.
_____________________
(Administering Officer)
(14) Sample Format of Evidence Custodian Report

_______________________________________
__________________________
RECEIPT OF EVIDENCE CONFISCATED
THIS IS TO CERTIFY that the undersigned receiving Police Officer

seized/confiscated the following described properties/items from the custody and control
of _____________________________, by virtue of Search Warrant No. _____ issued
by Honorable Judge ________________, Executive/Presiding Judge of Branch ______,
RTC, ___________ dated ______________ for Violation of _____________:
PROPERTIES/ITEMS CONFISCATED
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
______________
SIGNED IN THE PRESENCE OF:

1.) ______________________________________
2.) ______________________________________
__________________________
(Evidence Custodian)
(15) Sample of Chain of Custody Form

POLICE REGIONAL OFFICE 7
REGIONAL ANTI–ILLEGAL DRUGS
SPECIAL OPERATIONS TASK GROUP 7
Camp Sergio Osmeña Sr., Osmeña Blvd., Cebu City
CHAIN OF CUSTODY FORM
Nature of Case: Section 5 of Article II of RA 9165

Name of Suspect/s: __________________________
Time, Date and Place of Occurrence: At about 6:00 pm OF June 12, 2010, in front of
Metro bank along Wilson Street, Brgy. Addition Hills, San Juan City
Arresting Officers / Operating Unit: SPO1 Reynaldo M Pascua and PO3 Roderick G
Araneta SOU-3, PNP-AIDSOTF
Description of Evidence/s:
t.) One (1) black back pack with label sport.
u.) One (1) plastic bag containing white powder of suspected cocaine with marking
ITEM #1 with initial of SPO3 Ronaldo Parreño, Poseur Buyer and DTPO 6:00 PM,
June 12, 2010 along Wilson St. in front of Metro bank.
v.) One (1) plastic back containing white powder of suspected cocaine with
marking ITEM #2 with initial of SPO3 Ronaldo Parreño, Poseur Buyer and DTPO
6:00 PM, June 12, 2010 along Wilson St. in front of Metro bank.
w.) Wallet color black with label Marithe Francois containing driver’s license I.D.
Nuvalo Evo Living I.D., Pilipinas Hino Inc. named to __________ and other I.D.’s
x.) One (1) Unit Nokia cellular phone.
y.) Paper bag color blue labeled better net 777 with markings of the seizing officer.
z.) Paper bag color red labeled Marks & Spencer with markings of the seizing
officer.
aa.) One (1) paper bag color blue with containing forty (40) bundles of boodle
money with six (6) pcs of 500 peso bills placed on top earlier dusted with ultra violet
powder with markings of the seizing officer PO3 Roderick G. Araneta.
TURNED OVER BY : _________________________________

(Name and designation)
Agency / Address : _________________________________
Time and Date : _________________________________
Remarks : _________________________________
RECEIVED BY : _________________________________
Agency / Address : _________________________________
Time and Date : _________________________________
Remarks : _________________________________
TURNED OVER BY : _________________________________

Agency / Address : _________________________________
Time and Date : _________________________________
Remarks : _________________________________
(16) Sample of Certificate of Inventory

CONSOLACION POLICE STATION
Consolacion, Cebu
Date April 7. 2009
CERTIFICATE OF INVENTORY
THIS IS TO CERTIFY that an inventory was conducted in connection with the

following operation:
Nature of Case: Violation of Sec 11. Art II of RA 9165

Person Arrested : _______________________________
Date/Time of Arrest: 301430H July 2011
Place of Arrest: Zone 3 Brgy. Mantuyong, Mandaue City
This is to certify that the following item were seized during the said operation:
One (1) hand rolled white cigarettes believed to be marijuana were recovered from
his possession and control.
This certification is issued pursuant to the requirements of Section 21 (a), Article II

of Republic Act 9165.
PCI Insp LEONCIO B BALIGUAT JR.

Supervisor/Team Leader
Witnesses:
MEDIA: _______________________________
Print Name and Signature
Dept of Justice: ________________________

Elected Official: _________________________

Suspect/Rep: ___________________________
(17) Sample Format of Compliance/Return of Search Warrant

_________________________
Branch ___
_____________________________
PEOPLE OF THE PHILIPPINES

Plaintiff
Versus
Search Warrant no. _________
For violation of __________

_______________________
Respondents
x--------------------------------------x
COMPLIANCE/RETURN OF SEARCH WARRANT
Comes now, the undersigned applicant, _______________________ of the

______________ and unto this Honorable court, respectfully return the herein original
copy of the Search Warrant No. ________________ issued by the Honorable Presiding
Judge _____________, Branch _____, RTC _______ for violation of _____________.
(Attached hereto as annex “A” is the original copy of Search Warrant No.
__________) and manifest the following:
That at about ____________ of _______________, elements of the

____________ led by the undersigned implemented the search warrant no. ________
at the premises of _____________________ located at _______________.
That as a result thereof, the following items/articles which are subjects of the
search warrant were confiscated/seized under proper receipt as follows;
That the raid was conducted in a legally, peacefully and orderly manner and in the
presence of Two (2) Barangay Officials namely: Brgy Kagawad ________________ and
Brgy Executive Officer _________________ both of ______________. A corresponding
receipt of the evidence confiscated was furnished to the representative of
_________________. The registered owner of _____________, was not around during
the raid, however, was represented by ____________, the office administrator.
(Attached hereto as annex “B” is a copy of Receipt of Evidence Confiscated and
a Certification of Orderly Execution of Search Warrant as annex “C”)
WHEREFORE, it is most respectfully prayed to this Honorable Court that the return
of the Original Search Warrant No. ____________ and its annexes together with the
seized items be accepted.
LIKEWISE, it is respectfully prayed that the undersigned be authorized by this

Honorable Court or grants the ________________ to conduct Forensic Examination on
the seized computers and other electronic devices for evidentiary purposes.
Other relief’s just and equitable in the premises, are likely prayed for.
Done this _____ day of_____________ 20___, City of __________, Philippines.
___________________
Applicant Team Leader
SUBSCRIBED AND SWORN to before me this _____ day of _________ 20____

at City of Manila, Philippines.
________________
Presiding Judge
(18)Sample Form of Release Order (NPS Form 5)

OF _______________
__________________,
Complainant,
-versus- I.S. No. _______
Respondent FOR: _________
X_____________________x
RELEASE ORDER
(Of Recovered Article)
THE EVIDENCE CUSTODIAN

_________________________
_________________________
On the basis of request made by ____________________ for the release to his

custody of the articles/properties particularly described as follows:
You are hereby directed to release to said ___________________ the above

described articles/properties which are presently under your custody, unless the same
are being held for some other lawful causes.
_________________________________, Philippines _______________ 20_____
________________________
Inquest Prosecutor
APPROVED:
________________________
Received copy this ______________ day of ____________________ 20 ______.
________________________
Evidence Custodian
(19) Sample Form of Request of Release (NPS Form 6)

OF _________________
__________________,
Complainant,
-versus- I.S. No. _______
Respondent FOR: _________
X_____________________x
REQUEST FOR RELEASE

(Of Recovered Article)
_________________
_________________
I am respectfully requesting the release to my custody of certain

articles/properties, more particularly described as follows:
Which were recovered by the police authorities and presently in the custody of
____________ And in connection herewith I declare under oath:
That I am the lawful owner/possessor thereof, as evidence by

_________ Copies of which are hereto attached:
That said articles/properties are not instruments or tools in the
commission of any offense nor the proceeds thereof;
That I undertake to produce the same before your Office or the court
when so required;
That I have caused the said articles/properties to be photographed/
photocopied and certified by the police custodian as accurately presenting
the same;
That I affirm the affidavit/ statement executed by me on ___________
before ______________ and hereby bind myself under penalty of law to
appear and testify thereon in court when so required.
_________________, Philippines. _________________ 20__________
_________________________
Requesting Party
RECOMMENDING APPROVAL:
__________________________
Investigating Prosecutor
APPROVED:
________________________

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(1) Sample Format of Spot Report in Memorandum Form:

Republic of the Philippines

SUBJECT : SPOT REPORT

(Indicate briefly the time, date, and place of occurrence)

(Brief facts of the case)

Request/recommended actions from Hqs.

Progress Report will follow

Republic of the Philippines

FOR : CITY DIRECTOR

SUBJECT : SPOT REPORT re Arrested Suspect for Theft (Snatching) Alarm

DATE : October 19, 2012

1. Please be informed that OOA 04:50 PM of October 19, 2012 at Carmelite

2. Victim was represented by ________________ 20 years old, single, a resident of

4. Progress report will follow.

5. For information and request acknowledge receipt.

ENRIQUE LIMBAGA BELCIÑA, CSP

RAD MSG FOR XMSN

FM : CCMA STN 5 RESTD

FOR : OIC CMA MCPO (ATTN: OPN SEC) “P”

CNR : STN5C – 08 – 05 – 09 – 03 PD 05 AUG. 09

OR ABOUT 042230H AUGUST 09 ONE (1) _____________________

CONTAINING YELLOWISH SUBSTANCE BELIEVE TO BE ALPHA RUGBY PD SAID EVIDENCE

NOW MARKED AS "JCM" TO BE SUBMITTED AT THE REGIONAL CRIME LAB OFFICE PD

SUSPECT TEMPORARILY DETAINED AT THIS OFFICE READY FOR FILLING OF CHARGES IN

THE PROPER COURT PD PROGRES REPORT WILL FOLLOW PD REQUEST ACKNOWLEDGE

ALFREDO GUMINANG ORTIZ

Republic of the Philippines

SUBJECT : SPECIAL REPORT ON ____________

(State significant incident, place of occurrence, specific month, day,

(Other information relevant to the incident which may answer another

(Police action conducted-search, follow-up, pursuit operations, filing of

Other developments regarding the incident shall be submitted as soon

Republic of the Philippines

November 16, 2006

This pertains to the (what-significant incident) _________________

Further investigation disclosed that (other information relevant to the

Elements of (unit taking action) are/have (police action conducted-

Other developments regarding the incident shall be submitted as

BEINARC JOHN CANETE

REPUBLIC OF THE PHILIPPINES

SUBJECT : Beat Inspection Report

Time Inspected Team Personnel on Beat Place

Following Beat were replaced by the reserves for reasons indicated:

Request acknowledge receipt.

REPUBLIC OF THE PHILIPPINES

1st Shift Tour of Duty _________________________________ Date _____

Team Leader _________________________________________________

Driver ___________________________________ Car No. _____________

Time Location Purpose/Events Person Contacted

Republic of the Philippines

FOR : City Director

FROM : Chief, Police Station 4, MCPO

SUBJECT : Beat Inspection Report

DATE : 29 July 2012

1. That on or about 800H 23 July 2012, some personnel of this station

JIMMY ETULLE FORTES

Republic of the Philippines

SUBJECT : After Operation Report

III. Period Covered

IV. Area of Operations

VI. Chronological Events

ARRESTING OFFICER BRINGS THE

DESK OFFICER ENTERS INTO THE

ARRESTING OFFICER BRINGS

1st Shift Tour of Duty _____________________________ Date _

Driver _______________________ Car No. _

Name: ______________________________ Date:

Blotted Entry Nr: ___________ Date

Who was/were arrested by the (Rank/Name) ________

Received copy this _ day of _________ 20_.

BLOTTER ENTRY NR: __________ Date _

Case Report No. _________ Date _

FROM: ____ TO: _