NPS Investigation Form No. 01 s.

2011

Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
Makati City
I N V E S T I G AT I O N D ATA F O R M
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

Planters Development Bank, MARKDEV B. GONZAGA

(Represented by: Joseph Raymond G. Caparros) Zone 3 Kiraba, Bayabas,
Unit B 9th Floor Strata 2000, Emerald Cagayan De Oro City
Avenue, Ortigas Center, Pasig City

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

Estafa Asher F. Dionson

PDB Building, No. 314 Sen. Gil Puyat Ave.,
Makati City

DATE & TIME of COMMISSION PLACE OF COMMISSION

October 26, 2010, November 19, 2010 Makati City

January 24, 2011, February 18, 2012

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
3. Is this complaint related to another case before this office?* YES NO

I.S./NPS Docket No.:__________________

Handling Prosecutor:__________________

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

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 field any claim involving the same
issues in 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.

Joseph Raymond G. Caparros

(Signature over printed name)

SUBCRIBED AND SWORN TO before me this ____day of ________, 2013, in Makati City.

_____________________________________
Administering Prosecutor / Officer

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