Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE IOF THE PROVINCIAL/ CITY PROSECUTOR
Baguio City
INVESTIGATION DATA FORM
To be accomplished by the Office:
DATE RECEIVED: NPS DOCKET NO.:
(Stamped and initiated): .
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
Judy Anne E. Esteban, female, 32 years old Juan Dela A. Cruz, male, 36 years old,
Resident of Brgy., Tuel, Tublay, Benguet Resident of Brgy., Tuel, Tublay, Benguet
OFFENSE/S COMMITTED: WITNESS/S: Name & Address
HOMICIDE Carla L. Santos resident of 92 T.Alonzo St.
Baguio City and PO1 Jeriko Ong resident of
DATE & TIME OF COMMISSION: PLACE OF COMMISSION:
At or about 10:30 PM of December 28, 2019 Sunnyside Building, T. Alonzo Street, Baguio
City
1. Has a similar complaint been filed before any other office? YES NO x
2. Is this complaint in the nature of a counter- charge? YES NO x
3. Is this complaint related to another case before this office? YES NO x
I.S./NPS Docket No. .
Handling Prosecutor .
CERTIFICATION
I CERTIFY, under oath that all 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 a similar
action has been filed and/or pending, I shall report that facts 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 Prosecution Officer
*1,2,3 and CERTIFICATION need not be accomplished for inquest case.