Republic of the PhilippinesDepartment of JusticeNATIONAL PROSECUTION SERVICEPROVINCIAL PROSECUTION OFFICEDumaguete City

INVESTIGATION DATA FORMTo be accomplished by the Office

DATE RECEIVED:NPS DOCKET NO.: 00288_______________(Stamped and initialed)Assigned to: __________________________Time Received: __________________________Date assigned: __________________________Receiving Staff: __________________________

To be accomplished by the complainant/counsel/law enforcer(Use back portion if space is not sufficient)

COMPLAINANT(s): Name, Sex, Age & AddressRESPONDENT(s): Name, Sex Age & AddressMinor AAA, Female, 14 years old, Brgy.______Wilson Rada, Male, Brgy. Tandayag, Amlan___ Tandayag, Amlan_____________________________________________________________________________Minor BBB, Female, 16_years old, Brgy.___________________________________________________________Tandayag, Amlan____________________________________________________________________________________

OFFENSE(s) COMMITED/ LAW(s) VIOLATEDWITNESS(es):Name & AddressArt. 267 in relation to Art. 266-A of the___________________________________________________________ Revised Penal Code (Serious Illegal Detention____________________________________________________With Rape By Sexual Assault)______________________________________________________________________________________________________________________________________________________________________________

DATE & TIME OF COMMISSIONPLACE OF COMMISSIONMay 7, 2012_____________________________________Brgy. Tandayag, Amlan__________________________9 o clock in the morning____________________________________________________________________________

Has a similar complaint been filed before any other office?YES ( )NO ( )Is this complaint in the nature of counter-charge?YES ( )NO ( )Is this complaint related to another case before this officeYES ( )NO ( )

If YES, indicate detail below:

NPS 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 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 Court within five (5) days from knowledge thereof.

(Sgd.) Minor AAA(Sgd.) Minor BBBAffiantAffiant

SUBSCRIBED AND SWORN TO BEFORE ME, this 11th day of May 2012 in Dumaguete City, Philippines.

(Sgd.) Pros C. KyutorProsecutor I