Republic of the Philippines
Department of Justice
National Prosecution Service
OFFICE OF THE PROVINCIAL PROSECUTOR
Province of Cavite
______________
INVESTIGATION DATA FORM
(To be accomplished by the Office)
DATE RECEIVED: NPS DOCKET NO:
(stamped and initiated):__________________ IV-03-INV______________________________
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
LAW/S VIOLATED: WITNESS/ES:Name&Address
DATE & TIME of COMMISSION PLACE OF COMMISSION
1. Has a similar complaint been filed before any office? YES ___ NO ____
2. Is this complaint in the nature of counter charge? YES ___ NO____
3. Is this complaint related to another case before this office? YES ___ NO___ if yes indicate details below:
IS 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, quasi-
judicial agency, and that if I should thereafter learn that a similar action has been filed and/or pending, I shall report that fact
to this Honorable Office within five (5) days from knowledge thereof.
_________________________________________
Signature over Printed name
SUBSCRIBED AND SWORN to before me this _____________, __________________.
________________________________________
Prosecutor Administering Oath
*1,2,3, and Certification need not be accomplished for inquest cases