Sample Format of Complaint Sheet (Other Crimes)

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
______________________________________________________________________

COMPLAINT SHEET

Complaint No.________________ Date:

_________________
1. REPORTED THRU: 2. Previously Reported to other agency:
[ ] In Person [ ] Yes [ ] No
[ ] Telephone If yes;
[ ] Other a. To what agency
_____________________________
b. BY whom
__________________________________
c. Date/time
__________________________________

3. Nature of Complaint/Info 4. Place of Occurrence/Incident 5. Date/time

6. Name of Complainant/Informer 7. Address 8. Tel No.

9. Name(s) of Victim(s) 10. Age 11.Sex 12. Address 13. Tel No.

14. Name(s) of Suspect(s) 15. Alias 16.Sex 17.Age 18. Address

19. Name(s) of Witness(es) 20. Address 21. Tel No.

22. Brief facts/narrative of complaint (Use back page, if necessary)

23. Remarks of the receiving officer (especially if reporter refused to be identified):

a. Dialect (Accent): ________________________________

b. Female/Male:
c. Possible Age: __________________________________
d. Possible place where the caller is: ____________________________________
e. Intoxicated or not: _________________________________________________
f. Others:: _________________________________________________________

24. I certify that the details of the 25. SUBSCRIBED AND SWORN to before
complaint/info stated above are true and me this ____ day of April 2009 at Camp
correct to the best of my knowledge. Crame, Quezon City.

____________________
______________ Printed Name & Signature of
Complainant/Informer

26. Date/Time/Complaint/Info Received 27. Printed name/Signature of Receiving

Officer

28. Assigned to: 29. Noted by:

CONFIDENTIAL