Republic of the Philippines

Department of Justice
National Prosecution Service
OFFICE OF THE PROSECUTOR
QUEZON CITY

INVESTAGATION DATA FORM

To be accomplished by the Office
DATE RECEIVED NPS DOCKET NO.:
(stamped and initiated):_____________________ XV-03-INV-14____________-__________
Timed received:___________________________ Assigned to:__________________________
Receiving Staff:__________________________ Date Assigned:_______________________

To be accomplish by the complainants/ Counsel, Law Enforcer

(Use back portion if space is not sufficient)

COMPLAINANT/S: Name, Sex, Age & RESPONDENT/S: Name,Sex,Age, &

Address
LEONILA C. WATANABE, female, of legal age,
Filipino citizen, and residing at No. 23 Pingkian 1,
Central, Barangay Pasong Tamo, Tandang Sora,
Quezon City
Address
JOEY L. TABBU, and RONILA TABBU both of
legal ages, residing at 235 MacArthur Street, Area
1-A Pasong Tamo, Tandang Sora, Quezon City.

OFFENSE/S COMMITTED/ LAW/S VIOLATED: WITNESS/ES: Name & Adress

Joey Tabbu: for RA 9262, for ESTAFA, for Marites C. Torres and Elizabeth T. Delosata who
Malicious Mischief. are both residing at No. 23 Pingkian, Central,
Barangay Pasong Tamo, Tandang Sora, Quezon
Ronila Tabbu: for ESTAFA, for Malicious City
Mischief .

DATE & TIME OF COMMISSION: PLACE OF COMMISSION

December 2013 to Present Quezon City

1. Has a similar complaint been filed before any other office?* Answer: NO
2. Is this complaint is in the nature of a counter- affidavit?* Answer: NO
If yes, indicated details below.
3. Is this complaint related to another case before this office?* Answer: NO
If yes, indicate details below.

I.S./NPS Docket No.:__________________________________

Handling Prosecutor:________________________________

CERTIFICATION

I CERTIFY, under oath, 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 of filed any claim involving the same issues in any court, tribunal, or quasi-judicial agency,
and that I should thereafter learn that qa 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.

___________________________________
(Signature Over Printed Name)

SUBSCRIBED AND SWORN TO before me this_____day of _____________________,

20_____, in _____________________.

_______________________________________
Administering Prosecutor/ Officer

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