PNP BOOKING FORM - 1 “Medical Examination of Arrested Suspects

Request Form”

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
SAN MATEO MEDICAL CENTER

Date: Jun 12, 2023

Request for Medical Examination of Arrested Suspect/s

The Duty Physician:

Dr. Dela Cruz, Juan M.

Sir/Madam:

Respectfully request for the Medical Examination of the following suspects who
were arrested by personnel of this Office on June 12, 2023:

a. Jayson M. Bangayan sex: Male

Please furnish the arresting officer/escort officer, PCpl. BASILIA, NOEL JOHN V
a copy of the result of the Medical Examination for our reference.

Rest assured of our continuous support on matters of mutual interest. Thank you.

For the Chief of Police:

PSSg. BERGONIO, JERICHO G.

Signature of the Desk or Duty Officer
REF: (BLOTTER ENTRY NR:12345

PCpl. BASILIA, NOEL JOHN V.

Signature of the Arresting Officer
PNP Booking Form - 2A ”Medical Examination Result Sheet”
Republic of the Philippines
Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
SAN MATEO MEDICAL CENTER
M4M8+VVM, 100 Gen. Luna Ave, San Mateo, 1850 Rizal

MEDICAL EXAMINATION RESULT

BLOTTER ENTRY NR: 12345

Date: June 12, 2023

MEDICAL CERTIFICATE
To Whom It May Concern:

This is to certify that Mr./Mrs./Ms.______JAYSON M.

BANGAYAN________________,
22 y.o, Male, Single, a resident of BLK. 38 LOT 32 CLAYTON HEIGHTS GUINAYANG,
SAN MATEO, RIZAL, has been examined by undersigned and found
him/her__________
__________PHYSICALLY FIT, NO PHYSICAL INJURIES AS OF TIME
EXAMINATION______________

This certification is being issued upon request by the interest party for:
Transfer to Department of Health – Drug Treatment Rehabilitation Center at Brgy
Guitnang Bayan, San Mateo Rizal.

DR. JOHN WEAK

Asst. Hospital Director

NAME OF ARRESTING OFFICER/S:

PCpl. Noel John Basilia UNIT: San Mateo Police Department
PCpl. Jerilon Bayanin UNIT: San Mateo Police Dapartment

MEDICAL EXAMINATION CONDUCTED AT: San Mateo Medical Examination

BY: DR. John Weak ON: June 12, 2023

 Republic of the Philippines
Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
POLICE REGIONAL OFFICE 4A
RIZAL PROVINCIAL POLICE OFFICE
San Mateo Police Station
San Mateo Rizal
TURN-OVER OF ARRESTED SUSPECT
BLOTTER
ENTRY NR: 2023-12345 Date: June 12, 2023

This is to certify that the following arrested suspect/s identified as indicated:

Name: JAYSON M. BANGAYAN
Address: BLK. 38 LOT 32 CLAYTON HEIGHTS, GUINAYANG, SAN MATEO
Sex: Male Age: 22 DOB: January 06, 2021 POB Enrile Cagayan

Who was/were arrested on June 12 2023 at 3:00 pm?

This further certifies that the arrested suspect/s have been examined by
Dr. John Weak on June 12,2023 at San Mateo Medical Center.

Rank/Name/Signature of Duty Investigator Rank/Name/Signature of Arresting

Officer

P/Sgt. Jay D. Valenzuela PCpl. Noel John Basilia

PCpl. Jerilon Bayanin

Received By:

PSSg. BERGONIO, JERICHO G

Rank/Name/Signature of Duty Jailer
Time/Date: 9:00 pm/ June 12, 2023
Republic of the Philippines
Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
POLICE REGIONAL OFFICE 4A
RIZAL PROVINCIAL POLICE OFFICE
San Mateo Police Station
San Mateo Rizal

Suspect’s Personal Property Receipt Form

June 12, 2023
Date

This is to certify that the suspect’s personal properties/valuables as properly

itemized and described below was received for safe keeping. The items are as follows:

Items Detailed Description with Brand Name, Serial

Quantity Number and other identifiable characteristics
1

Turned over by: PCpl. Noel John Basilia Received by: PSSg. Jericho G.
Bergonio
Time/Date: 3:30 pm/ June 12, 2023 Time/Date: 3:30 pm/ June 12, 2023

Suspect’s acknowledgement (name and signature over printed name):

JAYSON MARAMAG BANGAYAN

Witnessed by:
Time/Date:
PNP BOOKING FORM 2 – “Arrest and Booking Form”

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
POLICE REGIONAL OFFICE 4A
RIZAL PROVINCIAL POLICE OFFICE
San Mateo Police Station
San Mateo, Rizal

Picture PNP ARREST AND BOOKING SHEET

2x2 (To be accomplished by the Arresting Officer)
FRONT VIEW
BLOTTER ENTRY NR: 2023-12345 DATE: JUNE 12, 2023

PERSONAL INFORMATION:
BANGAYAN JAYSON MARAMAG
(Last Name) (First Name) (Middle Name)
ADDRESS: #BLK. 38 LOT 32 CLAYTON HEIGHTS, GUINAYANG, SAN MATEO
TELL NO.: None POB: Enrile Cagayan DOB: January 06, 2001
MARITAL STATUS: X SINGLE WIDOW/ER SEX: X MALE
MARRIED SEPARATED FEMALE
AGE: 22 WEIGHTS (lbs.): 50 HEIGHTS (Ft): 5’4 EYES: BLACK HAIR: BLACK/SHORT
COMPLEXION: Brown OCCUPATION: Unemployed NATIONALITY: Filipino
ETHNIC GROUP: None DIALECT/LANGUAGE: Tagalog
HIGHEST EDUCATIONAL ATTAINMENT: College undergraduate
NAME OF SCHOOL: Bayangbang Colleges
LOCATION OF SCHOOL: San Mateo Rizal
IDENTIFYING MARKS: MOLE X TATOO BIRTHMARK SCAR
LOCATION OF IDENTIFYING MARKS: Left Arm
PHYSICAL DEFORMITY/DEFECT: None
DRIVER’S LIC NR: None ISSUED AT: ON:
RES CERT NR: None DATE AND PLACE OF ISSUE:
OTHER ID CARDS: None ID NR:
ARREST INFORMATION:
OFFENSE CHARGE: Violation of Article 293 (Robbery) of the Revise Penal Code B-23-06-12
(NATURE OF OFFENSE) (CRIM/IS NO.)
MODUS OPERANDA: None
WHERE ARRESTED: Brgy. Guitnang Bayan, San Mateo RIzal
DATE ARRESTED: June 12, 2023 TIME: 3:00 PM
ARRESTING OFFICER/S:
Rank: PCpl Name: Noel John Basilia Signature:
Rank: PCpl Name: Jerilon Bayanin Signature:
MEDICAL EXAMINATION CONDUCTED AT: San Mateo Medical Center
BY: DR. John Weak ON: January 12, 2023
REMARKS: Medical Examination
FINGERPRINT TAKEN BY: P02 Raymund Hilongos
PHOTO TAKEN BY: PO2 Raymund Hilongos
INVESTIGATOR ON CASE: P/Sgt. Jay D. Valenzuela
BOOKED BY (RANK/NAME/SIGNATURE): P/Sgt. Jay d. Valenzuela
SIGNATURE OF PERSON ARRESTED:
(INDICATE IF SUSPECT REFUSE TO SIGN)
OTHER INFORMATION:
NAME OF FATHER: Juan Bangayan AGE: 50
ADDRESS: San Mateo, Rizal
NAME OF MOTHER: Marlyn Bangayan AGE: 46
ADDRESS: San Mateo, Rizal
NAME & ADDRESS OF PERSON TO BE CONTACTED IN CASE OF EMERGENCY:
NAME: Kevin Bangayan RELATIONSHIP: Father
ADDRESS: San Mateo Rizal TEL #:None
LAWYER: None TEL #:
DOCTOR: None TEL #:
 HEALTH PROBLEM: None

FINGERPRINT RECORD SHEET

Name: JAYSON BANGAYAN D.O.B: JANUARY 06, 2021 F.I Number:4432/21H
Officer name: Officer no: 0003 Date: 12/06/2023
P02 Raymund Hilongos 0004

RIGHT HAND
1.Thumb 2.Index Finger 3.Middle Finger 4.Ring Finger 5.Little Finger

LEFT HAND
6.Thumb 7.Index Finger 8.Middle Finger 9.Ring Finger 10.Little Finger

Left Hand Four finger taken Note amputations Right Hand Four finger taken
simultaneously simultaneously
Thumb Plain Impressions
PNP Booking form 2B BOOKING MUG SHOTS

NAME OF SUSPECT: BANGAYAN JAYSON MARAMAG

(Family) (First) (Middle)
Blotter Entry Nr: 2023-12345
Republic of the Philippines
Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
SAN MATEO POLICE STATION
(Date) June 12,2023

THE HONORABLE CITY Chief PROSECUTOR

Office of City Prosecutor
San Mateo, Rizal

(Attn: Hon. James Ryan Bautista)

Greetings :

Respectfully referred to your good office for inquest proceedings are the herein
record of investigation relative to a case for Robbery committed at about 3:00 pm of
Monday, June 12, 2023 transpired at the General Luna Street, Brgy. Guitnang Bayan
San Mateo, Rizal.

COMPLAINANTS : MISS. RONALYN BRAVO, Legal age, female, Filipino,

single and a resident of Ilang-ilang Street Batasan Hills Quezon
City.

RESPONDENTS : MR. JAYSON M. BANGAYAN, 22 years old, male, Filipino,

single, and a resident Clayton Heights, Guinayang, San Mateo
(ARRESTED)

WITNESSES : MR. Joven m. BALISI, 28 years old, male, Filipino, single, and a
resident of Brgy. Ginayang Block 2 Lot 10 Easter View Sunnyside
annex 1.

Evidences : 1. kitchen knife

FACTS OF THE CASE:

On 12 June 2023 on or about 3:00 PM, the victim Ronalyn Bravo was passing
by General Luna Street, Brgy. Guitnang Bayan San Mateo, Rizal. While she was
passing by the said street, she notices one person following behind her. At first, she
ignored it but suddenly the said accused pointed a knife towards her neck and grabbed
her shoulder bag. Because of the terrible fear that the man would stab her if she did
not give her bag, she forces to give this the said accused containing with an android
phone, cash, and a power bank. After the man took her shoulder bag, she screamed to
ask for help. Then, fortunately there was two police officer patrolling near the place of
the said street where the crime was committed. But, after a few minutes, the robber
passed the two police officers. The police officers immediately captured the robber.
Later on, she positively identified the robber which is the one who was wearing a black
cap and black shirt.

ENCLOSURES:
a) Subscribed NPS Investigative Data Form
b) SS of the complainant
c) SS of witness
d) SS of witness
 e) Joint Affidavit of Arrest of
f) Medico-Legal Report
g) As stated, evidence recovered
h) Booking and Information of the suspect
i) And others to be presented later.

This case will be presented to you by P/Sgt. Jay D. Valenzuela of this office during
the course of inquest proceedings. Further, request furnished this office copy of
resolution of the case and either proceeding.

For appropriate action and deposition

PCOL. ALEXIE DESAMITO

CHIEF OF OFFICE
 REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF JUSTICE
NATIONAL PROSECUTION SERVICE
OFFICE OF THE CITY PROSECUTOR
PROVINCE OF RIZAL
THE PEOPLE OF THE PHILIPPINES
Complainant,

-vs- Case no. 12345

Robbery
JAYSON BANGAYAN,
Respondent,
X---------------------------------X

COMPLAINT-AFFIDAVIT
I, Ronalyn Bravo, of legal age, single and a resident of Ilang-ilang Street
Batasan Hills Quezon City, after being sworn in accordance with law depose and
say that:1. at around 3:00 P.M of Monday, June 12, 2023. I. Ronalyn Bravo was
passing by General Luna street, Brgy. Guitnang Bayan San Mateo, Rizal.
2. While I was passing by the said street I was holding a shoulder bag on
my right arm, walking in the moderate pace towards ICCT San Mateo Campus.
3. I noticed that there is one person following behind me. At first I ignored
it but suddenly he pointed a kitchen knife towards my neck and grabbed my
shoulder bag.
4. Because of terrible fear that the man would stab me if I did not give my
bag to him, I handed him my bag containing the following:
a) Android Phone
b) Cash
c) Power bank
5. That after the man took my shoulder bag, I screamed loudly the words
“Tulong, may magnanakaw kinuha yung bag ko”.
6. Then fortunately there was two police officer patrolling near the place of
the said street that the crime was committed.
7. After a few minutes the robber passed the two police officers. The police
officers immediately captured the robber.
8. Later on, I positively identified the robber which is the one who was
wearing a black cap and black shirt.
 9. That all these stated herein are true and were stated freely without any
force or intimidation done against me.
10. To attest to the truthfulness of the foregoing, I, Ronalyn Bravo,
complainant attaches my signature below.

____ Ronalyn Bravo____

Complainant
Republic of the Philippines )
____________, ________ ) s.s.
x- - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF WITNESS

I, Balisi, Joven M., 28, Single, resident of Brgy. Ginayang Block 2 Lot 10 Easter
View Sunnyside annex 1, after having sworn in accordance with law, do hereby
depose and state THAT:

01. I was present and personally saw that accused, Jayson Bangayan,
committed the crime of Robbery against the victim Ronalyn Bravo;

02. That at 3:00 P.M last June 12, 2023 at Brgy. Guitnang bayan San Mateo
Rizal, I saw one person pointing kitchen knife towards Ronalyn Bravo who just passing
by.
03. That time I was start panicking and immediately run out to the place.

04. That I found two police officers named PCpl Noel John Basilia, and PCpl
Jerilon Bayanin.

I executed this affidavit to attest the truthfulness of the foregoing facts and to
support the filing of Criminal Cases against Jayson Bangayan for violations of G.R. No.
45490.

AFFIANTS SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto affixed my signature this 12th day of June,

2023 at Brgy. Guitnang Bayan, San Mateo, Rizal.

_________JOVEN M. BALISI_______
Affiant

SUBSCRIBED AND SWORN to before me this _12th_ day of _June, 2023_ at

_Brgy. Guitnang Bayan, San Mateo, Rizal__. I HEREBY CERTIFY that I have
personally examined the herein affiants and I am satisfied that they voluntarily
executed and understood their given affidavit.

_____________________
Notary Public