PNP Booking Form -4 "Jailer's Receipt of Suspects" Form

Republic of the Philippines

PHILIPPINE NATIONAL POLICE
REGIONAL TRIAL COURT 3rd JUDICIAL REGION BRANCH 18 OF SILAY CITY

Blotter Entry Nr: 3134 Date: March 18, 2024

JAILER'S RECEIPT OF SUSPECT/S

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

Name:
Address: Nonas Osmena Ave. Victorias City, Negros Occidental
Sex: Male Age: 22 DOB: January 1, 2002 POB: Victorias City

who was/were arrested by Officer on March 15, 2024 at Victorias City, Negros Occidental were
turned over by Duty Investigator On March 15, 2024 to the Duty Jailer.

This further certifies that the arrested suspect/s have been examined by

Rank/Name/Signature of Arresting Officer/s

or

Rank/Name/Signature of Duty Investigator

Rank/Name/Signature of Duty Jailer

Time/Date: 2 P.M. - 03/18/24

Rank/Name/Signature of Witness