Republic of the Philippines
Department of Justice
National Prosecution Service
Office of the Provincial Prosecutor
Balayan, Batangas
INVESTIGATION DATA FORM
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
KATHREENE JAYNE C. HOLGADO SHARON INUMERABLE BOBADILLA
legal age, Filipino, married, resident of legal age, Filipino, resident of
Dacanlao, Calaca, Batangas Poblacion 5, Calaca, Batangas
LAW/S VIOLATED: WITNESS/ES: Name & Address
Estafa and Falsification CELESTINA LATORRE ATIENZA
Barangay 6, Calaca, Batangas
TERESITA E. NOCHE
Poblacion 5, Calaca, Batangas
DATE & TIME of COMMISSION: PLACE of COMMISSION:
July to October 2019 Calaca, Batangas
1. Has a similar complaint been filed before any other office:* YES ___ NO _X_
2. Is this complaint in the nature of a counter-affidavit?* YES ___ NO _X_ If yes, indicate details below.
3. Is this complaint related to another case before this office?* YES ___ NO _X_ If yes, indicate details below.
I.S. No. :
Handling Prosecutor:
C E R T I F I C A T 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 filed any claim involving the same issues with 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 thereof.
KATHREENE JAYNE E. HOLGADO
(Signature over printed name)
SUBSCRIBED AND SWORN TO before me this ________________________ in Balayan, Batangas.
Prosecutor Administering Oath