NPS Investigation Form No. 01 s. 2008 Republic of the Philippines Department of Justice NATIONAL PROSECUTION SERVICE PROVINCIAL PROSECUTION OFFICE Davap de Oro INVESTIGATION DATA FORM To be accomplished by the ae DATE RECEIVED: NPS DOCKET NO: X/- CF NW PFJ -C9AL (Stamped and initialle Time Rec: Receiving Staff Assigned to: Date Assigned To be accomplished by complainant/counsel/iaw enforcer: (Use back portion if space is not sufficient) COMPLAINANTIS: Name, Sex, Age & RESPONDENTIS: Name, Sex, Age & Address Address Kenverlyn S. Ansoban, of legal age Allan Lino, Albert Tumalis, Florante Mission, all of ‘And a resident of Purok 1-A, Bray legal age and all residents of Spl Brays LS Cabinuangan, Montevista, Davao del Sarmiento, Brgy Kidawa, Lak, Davao de Oro Norte eae FO 249. OFFENSE/S COMMITTED/LAW WITNESS/ES: Name & Address VIOLATED: Theft (Lino & Mission) ‘SSgt Rafael S. Pitchay. AFP Member Qualified Theft (Tumalis) Presently assigned at 60th IB PA, Bray Dofia Andrea, Asuncion, Davao del Norte Tap 7b FASE a DATE & TIME OF COMMISSION: PLACE OF COMMISSION: ‘At around 7:24 PM, Sept 27, 2021 Spl Bray LS Sarmiento, Bray Kidawa, Lak, Davao de Oro 1, Has a similar complaint been filed before any other office? YES NO_L 2. Is this complaint in the nature of a counter charge? YES NO 3. Is this complaint related to another case before this office? YES, No LS INPS Docket No Handling Prosecutor: CERTIFICATION® I CERTIFY, under oath that all the information on this sheet are true and correct to the best of my knowledge and belief, that | have not commenced any action or filed any claim involving the same issues in any court, tribunal or quasi-judicial agency, and tat if | should thereafter learn that a similar action has been filed andlor is pending, | shall report that fact to this Honorable Office within five (5) days from my knowledge thereof, fen — KENVERLYN S. ANSOBAN (Signature over printed name) de Oro, Philippines. “1, 2, 3 and CERTIFICATION need not be accomplished for inquest cases,Republic of the Philippines ) TAgUIG CITY) SECRETARY'S CERTIFICATE 1, HANA CHRISNA C. RUGA, of legal age, Filipino, with office address located at 3001- 3003 and 3016-3019, High Street South Corporate Plaza, Tower |, 26" comer 9* Ave., Bomticie Global City, Taguig City, afier being duly swom in accordance with law. do hereby state that 1 am the Corporate Secretary of ULTICON BUILDERS, INC. a corporation duly ‘organized and existing under and by virlue of the laws of the Republic of the Philippines. swith pancipal office address at UBL Compound, Don Julian Rodnguez Aventc, Mac, Davao City C*The Corporation”): 2. Ag such Corporate Secretary, 1 have custody and control over the corporate books and records of the sad corporation; ‘rhe corporation is 100% Filipina-owned. 4 Atthe meeting of the Board of Directors of the Corporation on Septembe: 27. 202 via Teleconference, during which a quorum was prescnt, the following resolutions on motion and duly recorded, were unanimously adopted and approves. WHEREAS, the Corporation intends 10 file a criminal case wih the stor's Office against four individuals for theft of Corporation's conszruction is properties RESOLVED, that the Board of Directors hereby authorizes and allow: ‘Corporation to initiate criminal actions against the following a. Albert Tomalis: b Aftan Leno: , Hlorante Mission. and dd. Joseiito Kapiti, RESOLVED FURTHER, that the Board of Directors hereby authorizes and allows KENVERLYN ANSOBAN, to represent the corporation im the initiation of the eriminal complaint against the abovementioned individuals RESOLVED FINALLY, that Ms. Ansoban shall have the posse sou authority to file, verify, sign the appropriate complaint or any initiatory pleading, execute the certifieate of non-forum shopping avid sign ‘other pertinent documents pertaining to the initiation of the seid eriminat proceeding. {certify that the foregoing resolution is in fall force und effect and has not heen abrogated. amended, moditied nor repealed S IN WITNESS WHEREOF, | have hereunto set my hand this HANA CPRESNA C, RUG. Cor Secretary