Republic of the Philippines

DEPARTMENT OF JUSTICE
NATIONAL PROSECUTION OFFICE
OFFICE OF THE CITY PROSECUTOR
Olongapo City

REFERRAL FORM FOR PRELIMINARY EVALUATION PI / INQ / CBU

REF. NO _______________________________________ NPS DOCKET NO. _________________________________________

Complainant/s: (and / or LEA’s) Respondent/s (and / or Suspect/ s)

Complete and Full Name, Unit, and /or Adress Complete and Full Name, and /or Adress
(NB: PLEASE STATE FULL CONTACT DETAILS – EMAIL ADDRESS & CP NUMBERS OF THE REFERRING ENTITY)

1. PSSg Ronne Jude G Alba 1. Ronald Rosapapan y Magpayo a.k.a Ronnie, resident of no. 23
2. PSSg Elmer R Dagal Coral St., Brgy. Gordon Heights, Olongapo City.
OCPO, PS5 – CP # 0998 598 5567 2. Evan Tinga y Daza a.k.a Boyet, resident of Diwa St., Block 3
Brgy. Gordon Heights, Olongapo City.
(Both Detained w/o waiver)

Offense / Law Violated: Time/Date/Place of Commission:

1. Violation of Section 5 in relation Sec. 26(b) At about 11:15PM of May 9, 2024, along Coral St., Brgy.
Art. II of RA 9165 (for Both Suspects) Gordon Heights, Olongapo City.
2. Violation of Section 11 Art. II of RA 9165 (for Suspect 1)
3. Violation of Section 15 Art. II of RA 9165 (for Suspect 2)

List of attached supporting documents/evidence:

1. Letter Referral 7. Request for Drug Test Examination and Result

2. Affidavit of Arrest and BWC Operator 8. PDEA Pre-Operation and Coordination
3. Inventory receipt and Chain of Custody of Evidence 9. Certificate of Coordination (COC) from PDEA
4. Photocopy of Buy Bust/Marked Money 10. Physical Examination of Suspect/s
5. Photographs 11. CD’s extracted from BWC/ARD’s
6. Request for Laboratory Examination and Result 12. Motion for Destruction of Seized Dangerous Drugs
and Drug Instruments

ATTESTATION

1. Has a similar complaint been filed before any other office? Yes ____ No _X__
2. Is this complaint in the nature of counter-charge? Yes ____ No _X__
3. Is this complaint related to another case before this office or any other office?
Yes ________ No _X__. If yes, indicate details ______________________________________________________

CERTIFICATION

I/We CERTIFY, under oath, that all the information on this sheet are true and correct to the best of my/our
knowledge and belief; that I/We, our unit/division, (or other LEA’s/ complainant) have not commenced any action or filed any
complaint involving the same issues in any prosecution Office; and that if I/We should thereafter learn that a similar
action/complaint has been filed and/or is pending, I/We shall report the same to this Honorable Office within twenty-four (24)
hours from knowledge thereof.

PSSg Ronne Jude G Alba PSSg Elmer R Dagal

(Signature over printed name) (Signature over printed name)
ID type & No.: PNP ID/ ID type & No.: PNP ID/ 21D1400462

SUBSCRIBED AND SWORN to before me this ______ day of May 2024 in the City of Olongapo, Philippines.