Investigation Form No. 01 s.

 2008

Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
Cagayan de Oro City

INVESTIGATION DATA FORM

To be accomplished by the Office:

DATE RECEIVED:       NPS NO.: X­06­INV­09____­0________

(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
SPS. HERBERT POLISTICO & JENNIFER
POLISTICO, of legal ages, Filipinos, married to
each other and residents of Block 14, Lot 6, Phase II,
Oro Habitat, Calaanan, Cagayan de Oro City
RESPONDENT/s: Name, Sex, Age & Address
SPS. DINDO HIBAYA & GERLY MAE
HIBAYA, of legal ages, Filipinos, married to each
other and residents of Block 49, Lot 17, Lotus St.,
Bloomingdale Subd., Iponan, Cagayan de Oro
City (formerly, residents of Block 17, Lot 19, Vista
Grande Subd., Lumbia Proper, Cagayan de Oro
City and with office at Brownman Indutries Inc.,
#168 Gumamela Ext., Carmen, Cagayan de Oro
city)

OFFENSE/s COMMITTED/ LAW/s VIOLATED: WITNESS/es: Name & Address
 
 Eleven (11) counts of  BP 22  and/or 
     under 
 ESTAFA  HERBERT POLISITICO
Article 315(d) of the Revised Penal Code JENNIFER POLISTICO
_______________________________________ MARA JUNE E. SADLUCAP
DATE & TIME of COMMISSION: PLACE of COMMISSION:
August 12, 2017; September 12, 2017; October 12,  Cagayan de Oro City_____________________
2017; November  24, 2017; December 24, 2017;  ______________________________________
January 24, 2018; February 24, 2018; March 24, 
2018; April 24, 2018; May 24, 2018; June 24, 2018 
______________________________________
1. Has a similar complaint been filed before any other office?* YES____ NO _/_
2. Is this complaint in the nature of a counter­charge?* 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./NPS Docket No.:_______________________
Handling Prosecutor:________________________
 
C E R T I F I C A T I O N*
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 quasi­judicial 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.

HERBERT POLISTICO JENNIFER POLISTICO

Affiant/Complainant Affiant/Complainant
Driver’s License K02-17-012788 Driver’s License K02-17-012789

SUBSCRIBED AND SWORN to before me this __________ in Cagayan de Oro City.