Republic of the Philippines

NATIONAL POLICE COMMISSION

PHILIPPINE NATIONAL POLICE
FORENSIC GROUP
Camp BGen Rafael T Crame, Quezon City

QUESTIONED DOCUMENT EXAMINATION DIVISION

Email: pnpcl_qded@yahoo.com

INSTRUCTION: Please use BLACK pen in filling-out this form. Put NONE if not applicable. Don’t leave blank.

___________________
Date

FAMILY NAME GIVEN NAME MIDDLE NAME NICKNAME Qualifier

PERMANENT ADDRESS: ___________________________________________________________________________________

STREET BRGY MUNICIPALITY/TOWN PROVINCE

PRESENT ADDRESS: _____________________________________________________________________________________

STREET BRGY MUNICIPALITY/TOWN PROVINCE

DATE OF BIRTH: ________________________PLACE OF BIRTH: ____________________________________ AGE: ________

NATIONALITY: ________________________________________CIVIL STATUS_______________________________________

LAST SCHOOL ATTENDED _________________________________ADDRESS OF SCHOOL____________________________

DEGREE: ________________________________HIGHEST EDUCATIONAL ATTAINMENT______________________________

PRESENT OCCUPATION: ______________________________ MOTHERS MAIDEN NAME _____________________________

SPOUSE’s NAME _____________________________________OCCUPATION OF SPOUSE _____________________________

CONTACT PERSON IN CASE OF EMERGENCY ________________________________________________________________

PRESENT ADDRESS: ________________________________________ CONTACT NUMBER____________________________

WRITE ALL THE LETTERS OF THE ALPHABET

1. Small letters in (long hand)_________________________________________________________________________________

________________________________________________________________________________________________________

2. Small letters in (script writing) ______________________________________________________________________________

________________________________________________________________________________________________________

3. Capital letters in (long hand) _______________________________________________________________________________

________________________________________________________________________________________________________

4. Capital letters in (block writing) _____________________________________________________________________________

________________________________________________________________________________________________________

5. Write number from (0 to 9) and punctuation____________________________________________________________________

HANDWRITING

1. Name in (long hand):_____________________________________________________________________________________

2. Name in (block writing): ___________________________________________________________________________________

3. Did you write with your left or right hand? _____________________________________________________________________

Not to be reproduced or photocopied without prior authorization from the FG Top Management
INSTRUCTION: COPY EXACTLY IN YOUR OWN HANDWRITING THE WHOLE PARAGRAPH BELOW
..……………………………………………………………………………………………………………………………
As Leonardo Luis E. Rapazo III in 105th Xavier guzzled his way through, three (3) bottles of brandy.
Mary Josephine Z. Quinzing, a partner in the Quezon City turned to John Richard Dick Ting Sr., a Chinese
food expert from Q.C. Kuantong Company Ltd. 346 Hadji Jairula Hussein Blvd., and said: I can’t speak for
my government but I’m quite sure your Company and mine better get together for closer understanding.

I HEREBY CERTIFY that the above data are true and correct and that the writing appearing hereon are
my true and genuine handwriting.

_____________________________
(Signature)

_____________________________
(Signature)

SUBSCRIBED AND SWORN to before me this______ day of____________20______at _________________________

_________________________________________________________________.

..………………………………………………………………………………………………………………………………………...

FOR FORENSIC GROUP PERSONNEL ONLY.

Prepared in the presence of 1) _________________________________________________________

Signature over printed name

2) _______________________________________________________________
Signature over printed name

RIGHT HAND THUMBMARK

WARNING: FALSIFICATION IS CRIMINAL OFFENSE AND PUNISHABLE UNDER THE REVISED PENAL CODE.
NOTE: A Copy of this document is retained by Questioned Document Examination Division for record and
reference.

Not to be reproduced or photocopied without prior authorization from the FG Top Management