Republic of the Philippines

Department of Justice
OFFICE OF THE PROVINCIAL PROSECUTOR OF BULACAN
Malolos City, Bulacan

INVESTIGATION DATA FORM

To be accomplished by the office

DATE RECEIVED: _______________________ NPS DOCKET NO.: _______________

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

Rosemarie Alde Alfon, female, 28 y/o Sarah Joy Bautista Manlapaz, female, legal age
0869 Gitnang Bukid, Mendoza Street, Brgy. Moriones St. Tondo, Manila
Bundukan, Bocaue, Bulacan______________ ________________________________________

OFFENSE/s COMMITTED/LAW/s VIOLATED; WITNESS/ES: Name & Address

Violation of Sec. 4(c)(4), of R.A 10175 in Randy Alde Alfon

relation to Art. 355 of the Revised Penal Code 0869 Gitnang Bukid, Mendoza St. Brgy. Bundukan,
Bocaue, Bulacan

DATE & TIME of COMMISSION: PLACE OF COMMISSION

February 05, 2021 10:33am Brgy. Bundukan, Bocaue, Bulacan. __