Police Regional Office 11
Camp Catitipan, Davao City
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Online Complaint Form
RECORDS OF EVENTS
*
Required Field
*
Reported Thru:
Complainants in Station
Phone Call/Fax
PROX1 Website/Email
Police Patrol
Others
Nearest PNP Office:
*
Previuosly Reported:
No
Yes
*
Date Reported:
January
February
March
April
May
June
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October
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December
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2011
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*
To Whom Reported:
By Whom:
*
Nature of Offense:
Robbery
Theft
Murder
Homicide
Rape
Drugs
Gambling
Women and Children Abused
Other (Please Specify)
*
Place of Occurrence:
Weapon Used:
No
Yes
Unsure
Type Of Weapon:
Vehicle Used:
No
Yes
Unsure
Type of Vehicle:
Lic. Plate of Vehicle:
*
Date of Occurrence:
January
February
March
April
May
June
July
August
September
October
November
December
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2010
2011
2012
Time:
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Complainant
Name:
E-Mail Address:
Tel. No.
Address:
Victim/s
1.
Name:
Sex:
Male
Female
Age:
1
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Tel. No.
Address:
2.
Name:
Sex:
Male
Female
Age:
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Tel. No.
Address:
3.
Name:
Sex:
Male
Female
Age:
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Tel. No.
Address:
4.
Name:
Sex:
Male
Female
Age:
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Tel. No.
Address:
5.
Name:
Sex:
Male
Female
Age:
1
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Tel. No.
Address:
Witnesses:
1.
Name:
Tel. No.
Address:
2.
Name:
Tel. No.
Address:
3.
Name:
Tel. No.
Address:
4.
Name:
Tel. No.
Address:
5.
Name:
Tel. No.
Address:
Suspect/s
1.
Full Name:
Alias:
Sex:
Male
Female
Age:
1
2
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Tel. No.
Address:
Description:
2.
Full Name:
Alias:
Sex:
Male
Female
Age:
1
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Tel. No.
Address:
Description:
3.
Full Name:
Alias:
Sex:
Male
Female
Age:
1
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Tel. No.
Address:
Description:
4.
Full Name:
Alias:
Sex:
Male
Female
Age:
1
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Tel. No.
Address:
Description:
5.
Full Name:
Alias:
Sex:
Male
Female
Age:
1
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Tel. No.
Address:
Description:
*
Particulars:
Action Requested:
I agree that by submitting this form that the information contained here is true and correct to the best of my knowledge.