Sample Format of Evidence Custodian Report

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
______________________________________
_______________________
RECEIPT OF EVIDENCE CONFISCATED
THIS IS TO CERTIFY that the undersigned receiving Police Officer seized/
confiscated the following described properties/ items from the custody and control of
______________________________________, by virtue of Search Warrant
No.________
issued
by
Honorable
Judge
________________________________,Executive/ Presiding Judge of Branch ______,
RTC, ____________________ dated ___________________ for Violation of
___________________________:
PROPERTIES/ ITEMS CONFISCATED
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_________________________________________________________
SIGNED IN THE PRESENCE OF:
1.)

____________________________

2.)

_____________________________

_____________________________
(Evidence Custodian)