NPS Investigation Form No.
01, s 2009
Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
Office of the City Prosecutor of Tacloban
Tacloban City, Leyte
INVESTIGATION DATA FORM
To be accomplished by the Office:
DATE RECEIVED: ___________________________ NPS DOCKET NO: _____________________________
(stamped and initialed): _____________________VII_-___-_____-_______________________________
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, & Address
Analiza Macanas
Female Avelina Gadugdug
52 Female
Blk 17 Lot 11 and 13 Phase 2, V and G Subdivision, Brgy. Lo-ok, Almeria, Biliran
Tacloban City
OFFENSE/s COMMITTED/ LAW/s VIOLATED WITNESS/ES: Name and Address
Qualified Theft – Article 310 of the Revised Penal Malyn B. Gervacio – Tacloban City
Code
DATE & TIME OF COMMISSION PLACE OF COMMISSION
February 16, 2025 – Initial item reported missing Blk 17 Lot 11 and 13 Phase 2, V and G Subdivision,
March 2, 2025 – Discovery of additional missing items Tacloban City
and police report filing
1. Has a similar complaint been filed before any other office?* YES NO X
2. Is this complaint in the nature of a countercharge?* 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. / NPS Docket No: I.S. No. 231547
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, 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.
ANALIZA MACANAS
(Complainant/s)
SUBSCRIBED AND SWORN TO before me this 30th day of ________April_________, 2025 in Tacloban City,
Leyte.
ATTY. BENEDICT BALBERIA
Prosecutor Administering Oath
*1,2,3 and Certification need not to be accomplished for inquest cases.