NPS Investigation Form No. 01 s.

2017

Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
OF TRECE MARTIRES, CAVITE

INVESTIGATION DATA FORM

To be accomplished by Office:

DATE RECEIVED: NPS DOCKET NO.:

(stamped and initialed): February 8, 2017 ______ 2017-13456
Time Received: _ .________________ Assigned to: __________________________
Receiving Staff: _ _____________ Date Assigned: _______________________

To be accomplished by complainant/counsel/law enforce:

(Use back portion if space is not sufficient)

COMPLAINANT/s: Name, Sex, Age & Address RESPONDENT/s: Name, Sex, Age, & Address
___ROY ANG ___Justine Biticon_________________________
___Male______________________________ ___Female_______________________________
___42 years old ___28 years old___________________________
__145 Brgy. Hugo Perez, ___ Brgy/ Inocencio,
Trece Martires City, Cavite _Trece Martires City, Cavite

OFFENSE/s COMMITED / LAW/s VIOLATION: WITNESS/es: Name & Address

___B.P. Blg. 22___________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
DATE & TIME of COMMISION:
__January 10, 2017_______________________
__2 o’clock in the afternoon_________________
__Linda M. Santos _______________________
___#789 Brgy. Lapidario, Trece Martires
___Cavite_______________________________
_______________________________________
_______________________________________
PLACE of COMMISION:
___SM Fairview__________________________
_______________________________________

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:
I.S. / NPS Docket No.: _______________________
Handing Prosecutor: ________________________

C E R T I F I C A T I O N*
I CERTIFY, under oath, 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 quasijudicial 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.

_____________________________________
ROY ANG

SUBCRIBED AND SWORN TO before me this 8th day of February 2017 in Trece Martires, Cavite.

_____________________________________
ATTY. CYNTHIA AGUILAR

*1, 2, 3, and CERTIFICATION need not to be accomplished for inquest cases