Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE OF THE PROSECUTOR
MANILA CITY

INVESTIGATION DATA FORM

To be accomplished by the Office:

DATE RECEIVED: NPS DOCKET NO.:

(Stamped and Initialed) ___________________ XV-07-INV .
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
____________________________________
_RAMON G. TALAN___________________
_____________________________________
____________________________________
RESPONDENT/s: Name, Sex, Age & Address
_____________________________________
RONALD C. PEREZ_____________________
_____________________________________
_____________________________________

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

_____________________________________ _JOSELITO P. VILLA- at No. 592 J.P.

Rizal __PERJURY under Art. 183______________ Street, Brgy.

Concepcion, Marikina City
__of the Revised Penal Code_____________ _____________________________________
_____________________________________ _____________________________________
_____________________________________ _____________________________________

DATE & TIME OF COMMISSION: PLACE OF COMMISSION:

______March 7, 2016___________________ ____Quezon City______________________
_____________________________________ _____________________________________

1. Has a similar complaint been filed before any other office?* YES____ NO____
2. Is this complaint in the nature of a counter- charge?* YES____ NO____ If yes, indicate details below
3. Is this complaint related to another case before this office?* YES____ NO____ if yes, indicate details below
4.
I.S./NPS Docket No. __________________________
Handling Prosecutor:__________________________

C E R T I F I C A T I O N*

I CERTIFY, under oath, that all the information in this sheet is true and correct to the best of my
knowledge and belief, I have not commenced any action r filed any claim involving the same issues in
any court, tribunal, quasi-judicial agency, and that if I should learn that a similar action has been filed
and/or is pending, I shall report that fact to this Honorable Court within five (5) days from knowledge
thereof.

________________________________________
(Signature over Printed Name)

SUBSCRIBED AND SWORN TO before me this ____________ day of ____________, 20___,

in _________________________________________.
Administering Prosecutor/ Officer