Republic of the Philippines

Zamboanga Del Sur

Pagadian City
X ----------------------------------- X

COMPLAINT-AFFIDAVIT
I, LEONORA OBANG, of legal age, Filipino and maybe served
with summons at of Santa Maria district, Pagadian City, after having
been duly sworn to in accordance with law, do hereby depose and
state that:
1. I am a human resource head in PLDT Company at Pagadian
City;
2. On December 14, 2016, Wednesday at 8 in the morning,
one of our employees, Mr. Evets Polutan, who was absent
for one week, submitted his Medical Certificate signed by
Dr. Josh Schultz as proof of his confinement for a week from
December 5, 2016 to December 11, 2016 due to severe
stomach pain. A copy of the Medical Certificate is hereto
attached and marked as Annex A and made as an
integral part of this Complaint Affidavit;
3. The accused, Mr. Evets Polutan demanded from a refund of
Hospital bills in order to compensate the absent on his duty;
4. Later, I was able to verify that the employee was actually
abroad for a vacation on December 5, 2016 until December
11, 2016, the period of his alleged confinement;
5. This was confirmed by Mr. Josh Bayani, his co-employee and
companion on the said vacation abroad. A copy of the
Affidavit of Witness is hereto attached and marked as
Annex B and made as an integral part of this Complaint
Affidavit;
6. Dr. Josh Schultz and Mr. Evets Polutan fully knew that the
certificate was false;
7. Despite the falsity of the said certificate, Mr. Evets Polutan
used the same to take advantage of the company;

8. I am executing this Complaint-Affidavit to charge Evets

Polutan, for FALSE USED OF MEDICAL CERTIFICATE,
defined and punished under Article 175 of the Revised Penal
Code for the using False of Medical Certificate;
9. I am executing this Complaint-Affidavit for the purpose of
attesting to the truth of the foregoing facts and events and
to pave the way for the prosecution of a criminal case for
Using False of Medical Certificate against Mr. Evets
Polutan and for whatever purpose this Complaint
Affidavit may serve best.

IN WITNESS HEREOF, I hereunto set my hand this 3 RD day of

January 2017 in Pagadian City.

LEONORA OBANG
Affiant
TIN No.: 001021123

SUBSCRIBED AND SWORN to before me this 3RD day of

January 2017 in Pagadian City.

JOHN
STEVE
SARIGUMBA
City Prosecutor
Pagadian City

Republic of the Philippines

CANTILA

City of Pagadian
Province of Zamboanga del Sur

VERIFICATION AND CERTIFICATION

OF NON-FORUM SHOPPING
I, LEONORA OBANG, of legal age, after having been duly sworn in
accordance with law, depose and state that:
1. I am a plaintiff in the above-stated case;
2. I caused the preparation of the foregoing complaint;
3. I have read the contents thereof and the facts stated therein are
true and correct of my personal knowledge and/or on the basis of
copies of documents and records in my possession;
4. I have not commenced any other action or proceeding involving
the same issues in the Supreme Court, the Court of Appeals, or any
other tribunal or agency;
5. To the best of my knowledge and belief, no such action or
proceeding is pending in the Supreme Court, the Court of Appeals,
or any other tribunal or agency;
6. If I should thereafter learn that a similar action or proceeding has
been filed or is pending before the Supreme Court, the Court of
Appeals, or any other tribunal or agency, I undertake to report that
fact within five (5) days therefrom to this Honorable Court.

LEONORA OBANG
Affiant
TIN NO.: 001021123
SUBSCRIBED AND SWORN to before me this 3RD day of January
2017 at Pagadian City affiant exhibiting to me his Community Tax
Certificate No. 30567098 issued on 3rd day of January, 2017 at
Pagadian City.

JOHN STEVE C. SARIGUMBA

City Prosecutor
Republic of the Philippines
City of Pagadian

ANNEX

Province of Zamboanga del Sur

AFFIDAVIT OF WITNESS
I, JOSH S. BAYANI, Filipino, of legal age, married and a resident of
Barangay Lumbia, Pagadian City. After having been duly sworn to in
accordance with the law, hereby depose and say
1. That I personally know Mr. Evets Polutan.
2. That last December 5, 2016 to December 11, 2016, I and Mr.
Evets Polutan was on abroad.
3. That I received a phone call from Ms. Leonora Obang inquiring
me as to whether or not Mr. Evets Polutan was confined in the
hospital from December 5 to December 11, 2016, I answered
NO, because during the said period we were together on
vacation.
4. That I am executing this affidavit to attest to the truth of the
foregoing facts and events and to pave the way for the
prosecution of a criminal case for Using false Medical
Certificate
against
Mr.
Evets
Polutan.
I WITNESS WHEREOF, I hereby affix my signature this 3 rd
day of January 2017 in the City of Pagadian, Zamboanga del
Sur, Philippines.

JOSH S. BAYANI
Affiant
TIN No.: 00202001

SUBSCRIBED AND SWORN TO before me this 3RD day of January

2017, in the City of Pagadian, Zamboanga del Sur, Philippines and I
further certify that I have personally examined the affiant and I
convinced and satisfied that he voluntarily executed the foregoing
Counter Affidavit and understood all the contents hereof and that
they are true and correct as to his own personal knowledge.

JOHN STEVE C. SARIGUMBA

City Prosecutor
Republic of the Philippines
DEPARTMENT OF JUSTICE

National Prosecutor Service

OFFICE OF THE CITY PROSECUTOR
Pagadian City, Zamboanga del Sur
NPS DOCKET NO. VII 11 12E -

LEONORA OBANG
A complainant,
-Versus- for:

VIOLATION OF USING FALSE

MEDICAL CERTIFICATE OR
ART. 175 (SECTION V OF
PENAL CODES)
EVETS POLUTAN,
Respondent.
X----------------------------/

SUBPOENA
TO: MS. LEONORA OBANG
STA. MARIA DISTRICT
PAGADIAN CITY
GREETINGS:
Under and by virtue of the authority vested in me by law, you are
hereby directed to submit your counter affidavit and other
supporting documents or affidavits of your witness if any, to sworn
before me on January 14, 2017 at 9: 00 oclock in the morning at
the Office of the City Prosecutor, City Hall, Pagadian City. Attached
is a copy of the complaint and other evidence submitted by the
complainant. You are hereby WARNED that failure on your part to
comply with the subpoena shall be considered submitted for
resolution based on the evidence on record WITNESS MY HAND this
9th day of January 2017 at Pagadian City, Philippines.
JOHN STEVE C. SARIGUMBA
City Prosecutor
____________________________________________________________________
CERTIFICATE OF SERVICE this is to certify that this 9 th day of January
2017, I have served a copy of the SUBPOENA upon the person/s to
whom it is addressed in accordance with law, and acknowledged
receipt of proper service as evidenced by his signature made hereof
by ________ in my presence or mailed it under Registered Mail No.
0214 dated January 9, 2017 PROCESS SERVER / WARRANT OFFICER.
Republic of the Philippines
PHILIPPINE NATIONAL POLICE
Pagadian City, Zamboanga del Sur

POLICE BLOTTER

ENTRY NO. ----- 021416 ---- 0001

1. That on or December 14, 2016, Wednesday at 8:00 oclock

in the morning, one of our employees, Mr. Evets Polutan,
who was absent for one week, submitted his Medical
Certificate signed by Dr. Josh Schultz as proof of his
confinement for a week from December 5, 2016 to
December 11, 2016 due to severe stomach pain.
2. The accused, Mr. Evets Polutan demanded from a refund of
Hospital bills in order to compensate the absent on his duty;
3. Later, I was able to verify that the employee was actually
abroad for a vacation on December 5, 2016 until December
11, 2016, the period of his alleged confinement;
4. This was confirmed by Mr. Josh Bayani, his co-employee and
companion on the said vacation abroad.

PO3 CARDO S. DALISAY

Police Investigator

Republic Of The Philippines

Department Of Interior And Local Government
NATIONAL POLICE COMMISSION
ZDS POLICE PROVINCIAL OFFICE
PHILIPPINE NATIONAL POLICE
PAGADIAN CITY POLICE STATION

MEMORANDUM
FOR: Provincial Director
ZDS Police Provincial Office
Camp Abelon, Brgy. Lumbia Pagadian City
FROM: Chief of Police
SUBJECT: 1st Progress Report on using false Certificate in PLDT
Company Pagadian City.
DATE: January 9, 2017
Reference: Spot Report on using false Certificate in PLDT Company
1. This pertains to the using false certificate that happens in
PLDT Company at 8:00 oclock in the morning on December
14 , 2016. Be informed that Ms. Leonora Obang the Human
Resource Head of PLDT Company has found out the false
using of Medical Certificate passed by the accused Mr. Evets
Polutan an employee of the said company.
2. Interview conducted on one of the co-worker identify as Mr.
Josh Bayani revealed that he is the companion of Mr. Evets
Polutan during the travel dated December 5, 2016
December 11, 2016.
3. Further development will be sent to that office as soon as
obtained.
4. For your information.

JOHN PASTOR
Police Superintendent

Republic Of The Philippines

Department Of Interior And Local Government
NATIONAL POLICE COMMISSION
ZDS POLICE PROVINCIAL OFFICE
PHILIPPINE NATIONAL POLICE
PAGADIAN CITY POLICE STATION

MEMORANDUM
FOR: Provincial Director
ZDS Police Provincial Office
Camp Abelon, Brgy. Lumbia Pagadian City
FROM: Chief of Police, PPS
SUBJECT: Spot Report of Using False Medical Certificate
DATE: January 9, 2017

1. On December 15, 2016, Wednesday at 8: 00 oclock in the

morning, PLDT Company Pagadian HR Head Ms. Leonora
Obang was complaining to there one employees, Mr. Evets
Polutan, who was absent for one week, submitted his false
Medical Certificate signed by Dr. Josh Schultz as proof of his
confinement for a week from December 5, 2016 to
December 11, 2016 due to severe stomach pain. But later,
Ms. Leonora Obang able to verify that the employee Mr.
Evets Polutan was actually abroad for a vacation on
December 5, 2016 until December 11, 2016, the period of
his alleged confinement. This was confirmed by Mr. Josh
Bayani, his co-employee and companion on the said
vacation abroad. Despite the falsity of the said certificate,
Mr. Evets Polutan used the same to take advantage of the
company.
2. The motive of incident is undetermined and the case still
under investigation.
3. Progress Report will follow.

JHON PAUL POLUTAN

Police Inspector