DPRM FORM RSD-03-A

Republic of the Philippines

National Police Commission
NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

AFFIDAVIT OF UNDERTAKING FOR PROMOTION

I, _________________________________________, of legal age, residing at
(Rank)

(First Name)

(Middle Name)

(Last Name)

____________________________ a member of Philippine National Police, presently assigned at

_______________________ designated to the position as __________________________
(Office/Unit)

_______________________ effective on __________________,

accordance with law, do hereby depose and state that:

after

having

duly

sworn

in

That, I am a candidate for promotion to the Rank of __________________________

In the Philippine National Police;
That, my highest educational attainment in a recognized institution of higher learning
is ______________________________________________;
(Baccalaureate/Masters/Doctorate Degree)

That, my highest promotional eligibility is __________________________________;

(NAPOLCOM Exam/CSC Prof/CSC PO/RA6506/PD 907/RA 1080)

That my highest mandatory training is ________

_______________________;

_____ which I completed on

That, all documents I have submitted to support my promotion for the rank of
___________________________ are genuine and authentic and that all the originals are now with
me for verification and/or comparison anytime;
That I have no pending case criminal or administrative; YES
That I was never suspended from my present rank; YES

NO
NO

FOR APPLICANT WITH PENDING CASE (S) OR SUSPENSION TO PRESENT RANK ONLY

That, I have pending case(s) or penalized hereunder;

CRIMINAL/
ADMIN CASE (s)

VENUE AND
CASE NR.

CASE STATUS
(Pending or
Resolved)

NATURE OF
OFFENSE (S)

PENALTY/
DECISION

DATE FILED/
PERIOD
PENALTY
IMPOSED

NOTE: Use extra sheet if necessary

That, I agree to the automatic nullification of my promotion and I hold myself

liable for perjury, falsehood, misinterpretation or omission or act of dishonestly for any
fraudulent, falsification or tampered documents that have submitted;
That, I have read and checked all entries appearing in my attached Personnel
Accounting and Information System (PAIS) Generated Personal Data and that I
certify that all entries thereof are true and correct;
That, I further certify that the foregoing declarations are true and accurate to the
best of my knowledge and ability and I hereby authorized the PNP to obtain and secure
pertinent records that will show my qualification standards, collateral requirements and case
record related to these declaration if any, in any agency or office.

_____________________________________
Affiant
SUBSCRIBED AND SWORN TO
__________________________ Philippines.

before

me

this

____

day

of

________,

_______________________
(NOTARY PUBLIC)

20___,

at

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF DAVAO DEL SUR)

MUNICIPALITY OF BANSALAN )
AFFIDAVIT
I, Jerome Lonzaga, 18 years old, single and a resident of Barangay Union,
Bansalan, Davao del sur after having been duly sworn to an oath in accordance with
law, do hereby depose and say:
That I am the same and identical person executing this instrument to shed light
to the complaint filed by Roy Alicaba Latayada against Jefferson Lahoy-lahoy also
known as Jun-Jun Lahoylahoy.
That on or about 6:00 PM dated May 18, 2014. I and Jefferson Lahoy-lahoy alias
Jun-Jun, roaming around at Brgy Buenavista particularly at the house of Roy Latayada
and while walking we planned to steal his motorcycle considering that the house of Roy
Latayada was unattended. That Jun-Jun Lahoy-lahoy destroyed the bamboo fence
installed at the back portion of the house but we did not yet enter the house due to his
motorcycle was not there;
That we decided to go to the waiting shed at the Barangay. Road at crossing
Brgy Buenavista. We wait until 12:00 midnight dated May 19, 2014; until a single
motorcycle passed by in front of us at the waiting shed. That after an hour we decided
to go back at the back portion of the said house and Immediately we enter the house
and alias Jun-Jun Lahoy-lahoy went upstairs where Roy Latayada was sleeping and
once inside alias Jun-Jun cover his face using handkerchief then pulled something on
his pocket and sprayed at the room. And he turned off the lights outside and instructed
me to hold the lighter with led light for him to clearly saw on cutting the chain lock of the
door.
That after few minutes Jun-Jun opened the door and pushed the motorcycle from
the house of Roy Latayada going outside of the gate and we help one another in
pushing the motorcycle until we reached at the river at Brgy Buenavista then Jun-Jun
removed quickly the side cover of the motorcycle in order the motorcycle cannot be
easily recognize and we left the side cover beside the river. A few minutes we continue
pushing the motorcycle until we reached at Villa Doneza Elementary School, Poblacion
Dos, Bansalan Davao del Sur then alias Jun-Jun lahoy-lahoy told me to go back to
bakeshop at Del Pilar St., Poblacion Dos, Bansalan Davao del Sur where I work.
That I am executing this instrument to apprise the authorities concerned for the
veracity and truthfulness of the foregoing facts and circumstances.
IN WITNESS HEREOF, I have hereunto affixed my name and signature below
this ____ day of May 2014 at Bansalan, Davao del Sur, Philippines.
Jerome Lonzaga
Affiant
SUBSCRIBED AND SWORN TO before me this _____ day of May 2014 at
Bansalan, Davao del Sur, Philippines. I HEREBY CERTIFY that I personally examined
the affiant and I am satisfied that he voluntarily executed the same and fully understood
the contents hereof.

PRIMITIVO B. GERALDE
Circuit Judge

REPUBLIC OF THE PHILIPPINES)

PROVINCE OF DAVAO DEL SUR) S. S.
MUNICIPALITY OF BANSALAN )
X-X-X-X-X-X-X-X-X-X-X-X-X-X-X-X
AFFIDAVIT COMPLAINT
I, Roy Alicaba Latayada, 22 years old, single, gasoline pump attendant, Filipino
Citizen and a resident of Brgy Buenavista, Bansalan Davao del Sur after having been
duly sworn to an oath in accordance with law, do hereby depose and say:
That I am the same and identical person who executed this instrument to file a
formal complaint of Carnapping against Jefferson Lahoy-Lahoy alias Jun-Jun LahoyLahoy.
That on or about 9:00 oclock in the evening of May 18, 2014, after my duty at
Phoenix Gasoline station located at corner Via Aldi St., Poblacion Dos and R. Delos
Cientos St., Poblacion Dos, Bansalan, Davao del Sur, I went home driving my single
motorcycle xrm 125 color red and white going to Brgy Buenavista, Bansalan,Davao del
Sur, when I arrived home I changed my clothes then I went to Gumamela st., Pob Uno,
Bansalan, Davao del Sur to attend vigil of my relative;
That on or about 12:00 midnight of May 19, 2014, I decided to go home driving
my single motorcycle and when I arrived home, I parked my single motorcycle inside
my house and I lock the door with chain;
That when I woke up at about 4:00 oclock in the morning of May 19, 2014, I
noticed the door of my house was already opened and I was caught by surprised when I
discovered that my single motorcycle was missing and nowhere to be found;
That I immediately went to my neighbors and asked them if they saw my
motorcycle, but they replied nothing until my cousin Danilo Bajao adviced me to go to
Bansalan Police Station and reported the incident and had it recorded into the police
blotter.
That sometimes on May 20, 2014, I received an information coming from
Bansalan Police Station that they arrested one Jerome Lonzaga by virtue of warrant of
arrest for the case of Robbery which prompted me to go to Bansalan Police Station and
met Jerome Lonzaga;
That while I and Jerome Lonzaga were in the process of conversation, he told to
me that he and one Jefferson Lahoy-lahoy alias Jun-Jun Lahoy-lahoy were the
responsible person in taking away my motorcycle sometimes on May 19, 2014, and I
am very much aggrieved for what Jefferson Lahoy-lahoy alias Jun-Jun Lahoy-lahoy did
to me thus I am executing this instrument to apprise the authorities concerned for the
veracity of the foregoing facts and circumstances.
IN WITNESS HEREOF, I have hereunto affixed my name and signature below
this ____ day of May 2014 at Bansalan, Davao del Sur, Philippines.
Roy A Latayada
Affiant
SUBSCRIBED AND SWORN TO before me this _____ day of May 2014 at
Bansalan, Davao del Sur, Philippines. I HEREBY CERTIFY that I personally examined
the affiant and I am satisfied that he voluntarily executed the same and fully understood
the contents hereof.

PRIMITIVO B GERALDE
Circuit Judge

Republic of the Philippines

NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE
BANSALAN MUNICIPAL POLICE STATION
Bansalan, Davao Del Sur

May 27, 2014

The Provincial Prosecutor
Department of Justice
Digos City, Davao Del Sur
Sir/Madam:
The undersigned Chief of Police of Bansalan Municipal Police Station
respectfully endorse unto your Honorable Office for evaluation and to file a formal
charges against Jefferson Lahoy-lahoy alias Jun-jun Lahoy-lahoy for Carnapping.
FACTS OF THE CASE;
That on or about 4:00 AM of May 19, 2014, his single motorcycle XRM 125 color
red with plate no.3123MO registered under the name of Rufina Latayada was
discovered lost while being parked inside of his house at Purok Uno, Brgy. Buenavista,
Bansalan Davao del Due. This incident was only notice by the owner when he
awakensfrom sleep.

Witness/es:
1. Roy A. Latayada- Barangay Buenavista, Bansalan, Davao del Sur.
2. Jerome Lonzaga- Barangay Union, Bansalan, Davao del Sur.
Exhibits:
1. Affidavit Complaint of Roy A. Latayada
2. Affidavit of Jerome Lonzaga
3. Extract copy of the Police Blotter
4. Copy of Official Receipt and Certificate of Registration of the motorcycle
5. Others to be submitted later.

.
JEFFREY CORSIGA LATAYADA
Police Senior Inspector

Republic of the Philippines

Department of Justice
NATIONAL PROSECUTION SERVICE
______________________
______________________
INVESTIGATION DATA FORM
To be accomplished by the Office
DATE RECEIVED: _________________________
(Stamped and initialed):____________________
Time Received: ___________________________
Receiving staff: ___________________________

NPS DOCKET NO.; _________________

Assigned to: _______________________
Date assigned: _____________________

_____________________________________________________________________
To be accomplished by complainant/counsel/law enforcer
(Use back portion if space is not sufficient)
COMPLAINAT/S: Name,Sex,Age &
Address

RESPONDENT/S: Name, Sex,Age&

Address

Roy A. Latayada, male, 22 years old,

Jefferson Lahoy-lahoy aka Jun-jun
A resident of Brgy Buenavista, Bansalan Lahoy-lahoy, male, Del Pilar Street
Davao del Sur.
Brgy. Pob. Dos, Bansalan Dvo.Del Sur
LAWS VIOLATED:

WITNESS/ES: Name & Address

Carnapping

Jerome Lonzaga a resident of Brgy

Union, Bansalan, Davao del Sur

DATE & TIME OF COMMISSION:

PLACE OF COMMISSION:

May 19, 2014 / 4:00 AM

Brgy Buenavista, Bansalan,

Davao del Sur

1. Has similar complaint been filed before any other office?

2. Is this complaint in the nature of a counter-charge?
If yes, indicate details below.
3. Is this complaint related to another case before this office?
If yes, indicate details below.

YES_____ NO ____
YES_____ NO ____
YES_____ NO ____

NPS 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 I have not commenced any action of filed any claim involving the same issues
in any court,tribunal,or quasi-judicial agency, and that if I should thereafter learn that a similar action has
been filed and/or is pending, I shall report that fact to this Honorable Office within five(5) days from
knowledge thereof.
_________________________
(Signature over printed name)
SUBSCRIBED
AND
SWORN
TO
before
me
of___________________,20____,In_____________________________.

this

_________day

___________________________
Prosecutor administering Oath