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Investigation Data Form Masusi

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Republic of the Philippines

Department of Justice
National Prosecution Service
Office of the Provincial Prosecutor
Province of Bataan
INVESTIGATION DATA FORM
To be accomplished by the Office

DATE RECEIVED : NPS DOCKET No. : XV-05-INV-


(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
EMILY JUMAGDAO JACLOP MYRNA METANTE JUMAGDAO
B31 Bayview Village Housing Batangas 2 ANA RAZEL JUMAGDAO BERDAJE
Mariveles Bataan ANGELINA METANTE JUMAGDAO
B01 Bayview Village Housing Batangas 2
Mariveles Bataan

LAW’S VIOLATED: WITNESSES: Name & Address


CYBER LIBEL IN REL. TO R.A. 10175 ULPIANO PION JUMAGDAO
VILMA JUMAGDAO SINGHBAL

DATE & TIME of COMMISSION: PLACE of COMMISSION:


February 2023 Mariveles Bataan

1. Has a similar complaint been filed before any other office: Yes___ No /
2. Is this complaint in the nature of a counter-Affidavit? Yes ___ No / if yes, indicate details below.
3. Is this complaint related to another case before this office? Yes ___ No / If yes, Indicate details below.
I.S. 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 ability 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.

EMILY JUMAGDAO JACLOP __


(Signature over printed name)

SUBSCRIBED AND SWORN TO before me this _________ day of _____________________


20___, at _________ City, Philippines.

_________________________________________
Assistant Provincial Prosecutor

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