Sample Format of Complaint Sheet (Carnapping Incident)

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
______________________________________

_______________________

Date: _____________________

COMPLAINT SHEET

Name of Suspects:
______________________________________________________________________
Last Known Address:
______________________________________________________________________
Nature of Offense:
______________________________________________________________________
Place Where Offense was Committed:
______________________________________________________________________
Date/Time Offense was Committed:
______________________________________________________________________
Local Police Office First Reported:
______________________________________________________________________
Date Reported:
______________________________________________________________________
Witness:
______________________________________________________________________

Brief Statement of Complaint Sketch

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__________________________________________
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__________________________________________
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Description of the Motor Vehicle

Make/Type Year Model Color

Plate Number Chassis Number Engine Number

MV File Number Registered Owner Address

CERTIFICATION

I, ___________________________________, after having been duly sworn to in

accordance to law do hereby depose and say:
That I am the complainant of the aforesaid complaint;
That I have read the essence and signed the same;
That all the allegations contained herein are true and correct to the best of my
knowledge and hereby warrant under penalty of perjury and;
That I will immediately inform the PNP-HPG in case the above described motor
vehicle is recovered (by us) so that alarm could be lifted.

Conformed By: _________________________ _______________________

(Registered Owner) (Driver)

Address: __________________________
Tel/Cell No. _______________________

SUBSCRIBED AND SWORN to before me this ______day of __________.,

affiant exhibited to me his/her Residence Certificate No.___________________ issued
at _____________ on ________________.

_________________

(Notary Public)
Note: Person found guilty of perjury is liable under Art. 183 of the Revised Penal
Code.