Republic of the Philippines
Department of Justice
                                                  National Prosecution Service
                                    OFFICE OF THE PROVINCIAL PROSECUTOR
                                                        Province of Cavite
                                                       ______________
                                              INVESTIGATION DATA FORM
                                                (To be accomplished by the Office)
 DATE RECEIVED:                                                   NPS DOCKET NO:
   (stamped and initiated):__________________                     IV-03-INV______________________________
   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
 LAW/S VIOLATED:                                                      WITNESS/ES:Name&Address
 DATE & TIME of COMMISSION                                            PLACE OF COMMISSION
 1. Has a similar complaint been filed before any office? YES ___ NO ____
 2. Is this complaint in the nature of counter charge?       YES ___ NO____
 3. Is this complaint related to another case before this office? YES ___ NO___ if yes indicate details below:
                                                                  IS No.:________________________________________
                                                                  Handling Prosecutor:__________________________
                                                        CERTIFICATION
          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 in any court, tribunal, quasi-
judicial agency, and that if I should thereafter learn that a similar action has been filed and/or 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 _____________, __________________.
                                                                      ________________________________________
                                                                              Prosecutor Administering Oath
         *1,2,3, and Certification need not be accomplished for inquest cases