NPS Investigation Form No. 01 s.

2008
Republic of the Philippines
Department of Justice
NATIONAL PROSECUTION SERVICE
Iloilo City Prosecution Office
Hall of Justice, Iloilo
INVESTIGATION DATA FORM
To be accomplished by the Office
DATE RECEIVED: NPS DOCKET NO.
(stamped and initialed): _________________ ____________________________________________
Time received: ___________________________ Assigned to: ___________________________________
Receiving Staff: __________________________ Date Assigned: _________________________________
_____________________________________________________________________________________________________________________
To be accomplished by the complainant/counsel/law enforcer:
(Use back portion if space is not sufficient)

COMPLAINANT/S: Name, Sex, Age & Address RESPONDENT/S: Name, Sex, Age & Address
SOCIAL SECURITY SYSTEM (SSS) GERARD LATAQUIN IBAÑEZ, owner,

address: TTW bldg., Mapa St. Iloilo City address: 3rd flr. Atrium Mall, Gen. Luna St., Iloilo City

OFFENSE/S COMMITTED: WITNESS/ES: Name & Address

In violation of Section 22 (a) in relation 1. Rey Mark V. Casaquite, SSS, Iloilo City
to Sec 28 (e) of R.A. 8282 __2. Others_________________________

DATE & TIME OF COMMISSION: PLACE OF COMMISSION:

April 12, 2016 Iloilo City

1. Has a similar complaint been filed before any other office? Yes_ No X
2. Is this complaint in the nature of a counter charge? Yes_ No X If yes indicate details below.
3. Is this complaint related to another case before this office? Yes_ No X If yes indicate details below.

NPS Docket No.___________________________

Handling Prosecutor: _______________________

C E R T I F I C A T I ON:
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 or filed Any claim involving the same issues in any
court, tribunal, or quasi-judicial agency, and that if I should therafter learn that a similar action has been filed
and/or is pending, I shall report the fact to this Honorable Office within five (5) days from knowledge hereof.

Very truly yours,

Atty. Bernardo B. Dofitas Jr.

Counsel for the SSS
VW2- Operations Legal Department
4th flr., SSS, Mapa St., Iloilo City

SUBSCRIBED AND SWORN to before me this 15th day of December 2017 in the City of Iloilo.

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