NPS Investigation Form No. 01, $.2008 Mepublic of che Philippines a ‘Beparhuent of Pustive Alaional Proseiutian Sesvice @ltice of the City Prosecucor INVESTIGATION DATA FORM To be accomplished by the Office DATERECEIVED : NPS DOCKET NO. (stamped and initiated) Time Recelved =: Assigned to Receiving Staff Date Assigned ‘To be accomplished by complainan/counseViaw enforcer (Use back portion # space is not sufficient) COMPLAINANT/S: Name, Sex, Age & Address RESPONDENT/S: Name, Age &Address_ LAWIS VIOLATED: WITNESS/ES; Name & Address DATE & TIME of COMMISSION: PLACE of COMMISSION: MAKATI CITY. l 7. Has a similar complaint been filed before any olher office YES NO _X_ 2. 4s this complaint in the nature of 8 counter-affidavil?* YES ___ NO_X_ If yes, indicate details below. 3. Is this complaint selaled to another case before this office?* YES ___NO_X_ If yea, indicale deta below. 1:8. No. pesca neo Handling Proseculor: — CERTIFICATION 1 CERTIFY, under oath that all the informations on thie sheet are true and correct to the best of my knovtledge.and belief, that | have not commenced any action or filed any claim inveiving the same issues in arly cout, Wibunal, or quasi judicial agency, and thet if | should thereafter team that a’similar action has been filed and’ or is pending, | shall report that fact to this Honorable Office within five (5) days from knowledge therof, ~——ignalure over printed name) SUBSCRIBED AND SWORN TG before me this. _._ day of ___ rnsecutor Administering Gall