Republic of the Philippines

Department of the Interior and Local Government

NATIONAL HEADQUARTERS PHILIPPINE NATIONAL POLICE

CRIME LABORATORY
DNA ANALYSIS SECTION
Camp Crame, Quezon City
CONSENT FORM
(INFORMATION SHEET)
(PLEASE WRITE CLEARLY)

SAMPLE CODE: ___________________

Date: _____________

REFERENCE CASE NR: _____________

A.
I, _______________________________ the _____________________________
of _______________________________________do hereby declare and state the following:
That, I gave my consent to the duty DNA Analyst,_________________________ of the
PNP Crime Laboratory, DNA Analysis Section to collect biological sample from
___________________________ for DNA analysis as standard reference for identification.
B.
PLEASE COMPLETE THE FOLLOWING: (Please Print)
(CHILD'S DATA)
Last Name: ______________________ First Name: _______________ Race: ________
Address:________________________________________________________________ Contact
Number: __________________Date of Birth: ___________________________
Date Collected: ___________________ Relation: _______________________________
Type of Sample Collected: ______________________
Remarks:________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
C.
Photograph

Thumb Prints

LEFT

RIGHT

________________________________
Signature

Requesting Party: _________________________________________________________

Address: ________________________________________________________________
________________________________________________________________
Contact Number: _________________________________________________________
D.
I, ______________________________(name of DNA personnel) did assist in the taking
of biological sample/s from the individual listed above.

_________________________
Signature of Collecting Officer

Witnesses: (Signature above Print Name)

Address

1. _____________________________

______________________________

2. _____________________________

______________________________

3. _____________________________

______________________________

Republic of the Philippines

Department of the Interior and Local Government
NATIONAL HEADQUARTERS PHILIPPINE NATIONAL POLICE

CRIME LABORATORY
DNA ANALYSIS SECTION
Camp Crame, Quezon City
CONSENT FORM
(INFORMATION SHEET)
(PLEASE WRITE CLEARLY)

SAMPLE CODE: ___________________

Date: _____________

REFERENCE CASE NR: _____________

A.
I, _______________________________ the _____________________________
of _______________________________________do hereby declare and state the following:
That, I gave my consent to the duty DNA Analyst,_________________________ of the
PNP Crime Laboratory, DNA Analysis Section to collect biological sample for DNA analysis as
standard reference for identification.
B.
PLEASE COMPLETE THE FOLLOWING: (Please Print)
(INFORMATION DATA)
Last Name: ______________________ First Name: _______________ Race: ________
Address:________________________________________________________________ Contact
Number: __________________Date of Birth: ___________________________
Date Collected: ___________________ Relation: _______________________________
Type of Sample Collected: ______________________
Remarks:________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
C.
Photograph

Thumb Prints

LEFT

RIGHT

________________________________
Signature
Requesting Party: _________________________________________________________
Address: ________________________________________________________________
________________________________________________________________
Contact Number: _________________________________________________________

D.
I, ______________________________(name of DNA personnel) did assist in the taking
of biological sample/s from the individual listed above.

_________________________
Signature of Collecting Officer

Witnesses: (Signature above Print Name)

Address

1. _____________________________

______________________________

2. _____________________________

______________________________

3. _____________________________

______________________________