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Preliminary Evaluation PI INQ FORM

The document is a preliminary evaluation form from the Department of Justice in the Philippines regarding a complaint or investigation. It collects information about the complaint, respondent, offenses alleged, supporting documents, and asks whether similar complaints have been filed elsewhere.

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1K views

Preliminary Evaluation PI INQ FORM

The document is a preliminary evaluation form from the Department of Justice in the Philippines regarding a complaint or investigation. It collects information about the complaint, respondent, offenses alleged, supporting documents, and asks whether similar complaints have been filed elsewhere.

Uploaded by

makicatapang23
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF JUSTICE
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
San Pablo City, Laguna

PRELIMINARY EVALUATION PI/INQ FORM


NPS DOCKET NO.__________________________ Received By: _____________________
Assigned to ________________________________ Date and Time Received: ____________
Date Assigned to: ___________________________

Complaint/s: (and/or LEAs) Respondent/s (and/or Suspect/s)


Complete and Full Name, Unit, and/or Address Complete and Full Name, and/or Address

_____________________________________ _____________________________________

_____________________________________ _____________________________________

_____________________________________ _____________________________________

Offense/Law Violated: ________________________ Place of Commission: ______________________


Date and Time of commission: _________________

List of attached supporting documents/evidence:

1. _________________________________________

2. _________________________________________

3. _________________________________________

4. _________________________________________

5. _________________________________________

ATTESTATION

1. Has a similar complaint been filled before any other 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
Or any other office? If yes, Indicate details _________________

CERTIFICATION

I/WE CERTIFY, under oath, that all information on this sheet are true and correct to the best of my/our
knowledge and belief; that I/We, our unit/division, (or other LEAs/complaint) have not commenced any action
or filed any complaint involving the same issues in any court, Prosecution Office, tribunal, or other quasi-
judicial agency, and that if I/We should thereafter learn that a similar action/complaint has been filed and/or is
pending, I/We shall report the same to this Honorable Office within twenty-four (24) hours from knowledge
thereof.

Name and Signature of Complainant/s and/or


SUBSCRIBED and SWORN to before me this _______________ day of ______________ 2023 in the
City of San Pablo, Laguna, Philippines.

________________________________________

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