NPS Investigation Form No. 01 s.

2008

Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
Province of Nueva Ecija
Cabanatuan City

INVESTIGATION DATA FORM

To be accomplished by Office:

DATE RECEIVED: NPS DOCKET NO.:

(stamped and initialed): ___________________ ____________________________________
Time Received: _________________________ Assigned to: __________________________
Receiving Staff: _________________________ Date Assigned: _______________________

To be accomplished by complainant/counsel/law enforce:

(Use back portion if space is not sufficient)

COMPLAINANT/s: Name, Sex, Age & Address RESPONDENT/s: Name, Sex, Age, & Address
Esperanza T. Cruz, F, 57 y/o, Mayapyap
_______________________________________ Brgy. Captain Renato D. Torres (M), Joenell Vergara (M),
_______________________________________
Norte, Cabanatuan City, Nueva Ecija
_______________________________________ Nerissa Verde (F), Ernesto Estrada (M), Amado Acierto (M),
_______________________________________
David De Leon (M), Reynante De Leon (M), Samson Sevidal
_______________________________________ _______________________________________
_______________________________________ (M), Gaudencio Dionisio (M), Reynaldo Tolentino (M),
_______________________________________
Rodolfo Torres (M) All of Mayapyap Norte, Cabanatuan City
_______________________________________ _______________________________________

OFFENSE/s COMMITED / LAW/s VIOLATION: WITNESS/es: Name & Address

Violation of Sec. 77 ( formerly Sec. 68 of PD 705
_______________________________________ Advilord Ivan Soriano, Ethel Soriano, Domingo Alcazar-
_______________________________________
renumbered pursuant to RA 7161 )
_______________________________________ all of Mayapyap Norte, Cabanatuan City
_______________________________________
_______________________________________ Orvel Pagaduan, Ernesto Dalangin, Cirilo Castro, Julio
_______________________________________
_______________________________________ Bangtuan Jr. – DENR-CENRO Cabanatuan City
_______________________________________
_______________________________________ _______________________________________
DATE & TIME of COMMISION: PLACE of COMMISION:
July 1, 2018/ 10:00 AM
_______________________________________ Mayapyap Norte, Cabanatuan City
_______________________________________
_______________________________________ _______________________________________
X
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 X
___ If yes, indicate details below:
3. Is this complaint related to another case before this office? * YES ___ NOX___ If yes, indicate details below:

I.S. / NPS Docket No.: _______________________

Handing Prosecutor: ________________________

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

ESPERANZA T. CRUZ
_____________________________________
(Signature over printed name)

SUBCRIBED AND SWORN TO before me this _________________________________________________ ,

Here at ________________________________________________.

_____________________________________

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

 NPS Investigation Form No. 01 s.2008

Administering Prosecutor / Office

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