NPS Investigation Form no. 01, s.
2008
Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
CITY PROSECUTION OFFICE
City of Koronadal
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 complainant/ counsel/ law enforcer
(Use back portion if space is not sufficient)
COMPLAINANT/s: Name, Sex, Age & Address RESPONDENT/s: Name, Sex, Age &
Address
IMEE D. CAM CITY MALL OF KORONADAL
Gensan Drive, Brgy. Zone IV,
City of Koronadal
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__________________________________________ ___________________________________________
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LAW/S VIOLATED: WITNESS/ES: Name &Address
__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
__________________________________________
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__________________________________________ ___________________________________________
DATE & TIME of COMMISION: PLACE of COMMISSION:
__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
NPS Investigation Form no. 01, s. 2008
1. Has a similar complaint been filed before any other office? * YES____ NO___
2. Is
this complaint in the nature of a counter- charge? * YES____ NO___ If yes, indicate
details below
3. Is
this complaint related to another case before this office? * YES___ NO___ If yes, indicate
details below
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.
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SUBSCRIBED AND SWORN TO before me this _________________, in General Santos City,
Philippines.
_____________________________
Prosecutor Administering
Oath
