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    Republic of The Philippines Department of Justice National Prosecution Service Office of The City Prosecutor Passi City, Iloilo

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    joshua

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    Republic of The Philippines Department of Justice National Prosecution Service Office of The City Prosecutor Passi City, Iloilo

    Uploaded by

    joshua
    16 views1 page

    Original Title

    Investigation Data Form

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    Republic of The Philippines Department of Justice National Prosecution Service Office of The City Prosecutor Passi City, Iloilo

    Uploaded by

    joshua

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines

    Department of Justice
    NATIONAL PROSECUTION SERVICE
    OFFICE OF THE CITY PROSECUTOR
    Passi City ,Iloilo

    INVESTIGATION DATA FORM

    DATE RECEIVED: NPS DOCKET NO:


    (Stamped and Initialed}:
    Time Received : Assigned To :
    COMPLAINANT/s : Name, Sex, Age & Address RESPONDENTS/s Name, Sex, Age & Address
    Joselito Mondejar ,male,45yrs old, Sitio Kabanatian 1. Jose Broniola Alias Asot 50 Sitio Kabanatian
    Brgy. Tumanding, Arakan , otabato Brgy. Tumanding, Arakan, Cotabato

    OFFENSE/s COMMITTED/LAW/s VIOLATED: WITNESS/es Name and Address:

    Rape with Homicide


    DATE & TIME of COMMISSION: PLACE of COMMISSION:
    February 28,2000 Sitio Kabanatian Brgy Tumanding , Arakan,
    Cotobato
    ______________________________________________________________________________________
    1. Has similar complaint been filed before any other office? YES _____ NO _ /__
    2. Is this similar complaint in nature of counter-charge? YES _____ NO __/__
    3. Is this complaint related to another case before this office? YES _____ NO _/___
    I.S. / NPS Docket 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 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.

    JOSELITO MONDEJAR
    Complainant

    SUBSCRIBED AND SWORN to before me this __th day of February 2000, Philippines.

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