NPS Investigation Form No. 01 s.

2008

Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
___________________________________
___________________________________

INVESTIGATION DATA FORM

To be accomplished by the Office
DATE RECEIVED: NPS DOCKET NO:

(stamped and initialed):_________________________________________________________________________

Time received: __________________________________ Assigned to:______________________________
Receiving Staff: ___________________________________ Date Assigned:____________________________

To be accomplished by complainant/counsel, law enforcer:

(Use back portion if space is not sufficient)
COMPLAINANT/S: Name, Sex, Age & Address RESPONDENT/S: Name, Sex. Age & Address

KHARISSA BADO VILLAMOR, 27 years old, NABIL MANTAR y BASMAN, 23 years old, married,
single, supervisor of Unitop General jobless and a resident of Cabingan, Marawi City,
Merchandise located along Quezon Lanao del sur
Avenue, Barangay Poblacion, Iligan City

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

THEFT

DATE & TIME of COMMISSION: PLACE of COMMISSION:

More or less around 04:35 pm of July 23, Unitop Merchandise, Along Quezon Avenue,
2019 Barangay Poblacion, Iligan City

1. Has a similar complaint been filed before any other office?
2. Is this complaint in the nature of a counter charge?
below:
3. Is this complaint related to another case before this office?
below:
YES_______ NO_______
YES_______ NO_______ If yes, indicate details
YES_______ NO_______ If yes, indicate details

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 any 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.

Affiant:

KHARISSA BADO VILLAMOR

SUBSCRIBED AND SWORN TO before me this 24th day of July 2019 in Iligan City, Philippines.

Administering Officer

1,2,3 and CERTIFICATION need not be accomplished for Inquest cases.