Republic of the Philippines

DEPARTMENT OF JUSTICE
NATIONAL PROSECUTION SERVICE
Office of the Secretary
Padre Faura St., Ermita, Manila

________________,
Complainant-Appellant,
- versus

________________,
Respondent-Appellee.
x - - - - - - - - - - - - - - - - - - - - - - - - -x

PETITION FOR REVIEW

COMES NOW, the undersigned petitioner, unto this Honorable Office respectfully avers:

1. That on _________ the undersigned Chief of Police of ____(state the unit and postal
address)_______ upon complaint of the private offended party filed a case against _____(state
the name and postal address of the respondent)_ for ___(designation of offense)__ docketed
under IS No.____ before the Office of Honorable _________ located in ______ where the
preliminary investigation took place;

2. That for the information of the Honorable Secretary this case started ___(give the concise facts
of the case)

3. That on _____(date)___ the undersigned received the Resolution of the Honorable Prosecutor
copy of which is attached as Annex A disposing the case as follows:

Note: Copy the dispositive portion of the resolution.

4. That the undersigned ______(pls give ur analysis how the Prosecutor disposed the case) ___.

5. That with due respect to the Honorable Prosecutor, the undersigned believed that he
committed error on the following:

Note: Cite now the matters that adversely affect your case specifically pinpointing the law that
supports your position

6. Attached as integral part of this petition are the following:

a) Proof of service of this Petition to the Honorable Prosecutor (Annex B)

b) Proof of service of this Petition to the Appealee
c) Other Records of the Case

WHEREFORE, the undersigned respectfully prays for the setting aside of the appealed
resolution of Prosecutor __________ dated _____and that the honorable prosecutor be directed
to file information (blah blah cite now the relief that you want if you have any)_____

Other reliefs just and equitable are likewise prayed for.

____Place________. ____Date_____.

______________________
Chief of Police

VERIFICATION

JURAT

Copy furnished:
- Prosecutor
- Respondent