Republic of the Philippines
NATIONAL POLICE
COMMISSION
NATIONAL HEADQUARTERS PHILIPPINE NATIONAL POLICE
CIVIL SECURITY GROUP
Firearms and Explosives Office
Camp Crame, Quezon City
Write in all capital letters & mark (d)the BOX providedif needed
LOST FIREARM T&GGI/4G REQUEST FORN
Control No. Date ” ”
IIIFORMATlON€IFR €IUEET/NG ENTITY
raaxema I I I
First Namo
Q‹ialift er
fiompery /«vz»
ADDREA6 OF THE REARIt8 3LD5B .
F ¥J‹
Unit NO:/BId
.st«eoe»
cg•iwnispaar
CORTAGT xns.
FiREABlb/E. DA“TA ”
KIND MAKE/MODEL CALIBER SERIAL NUMBER
[To bef'fIIed out gy Veri]'ier/Togger Only)
TAGGED AS UI ON:
Verlfierj/Tagger:
[To be]fiIled out by Duty I & £ Section Personnel Onty)
CHECKLIST OF REQUIREMENTS
LOST FIREARM TAGGING REQUEST FORM ORIGINAL SPECIAL BANK RECEIPT (Amount: Php
ORIGINAL INVESTIGATION REPORT ORIGINAL CERTIFICATE OF POLICE BLOTTER
ORIGINAL AND NOTARIZED AFFIDAVIT OF LOSS DEATH CERTIFICATE (If Licensee is deceased)
SPECIAL POWER OF ATTY (SPA) IF REQUESTED THROUGHA REPRESENTATIVE
PTCFOR IF LOST OUTSIDE OF RESIDENCE
DATE FILED: REMARKS:
DATE OF INCIDENT:
DATE REPORTED:
Received By:
Signature of Applicant Duty I & E Section, EEMD