ACTIVITY FOR: POLICE LEGAL FORMS

Name: Bernardino, Donita & Calledo, Ronel

INSTRUCTIONS: (30 POINTS)
1. GROUP WORK (2 MEMBERS IN EACH GROUP)
2. EACH OF THE MEMBERS MUST FILL UP THE COMPLAINT FORM SHEET. ONE MEMBER MUST FILL
UP THE CARNAPPING INCIDENT FORM AND THE OTHER MEMBER MUST FILL UP THE OTHER
CRIMES FORM. THE FORMS MUST BE SUBMITTED ON OR BEFORE THE SUBMISSION DATE.

ACTIVITY FOR: WARRANT OF ARREST AND SEARCH WARRANT

INSTRUCTIONS: (30 POINTS)
1. GROUP WORK (2 MEMBERS IN EACH GROUP)
2. EACH OF THE MEMBERS MUST FILL UP THE ARREST AND BOOKING FORM SHEET. ONE MEMBER
MUST FILL UP THE FORM NAMING THE OTHER TEAM MEMBER AS THE PERSON BEING ARRESTED AND
HE/SHE ACTING AS THE ARRESTING OFFICER. LIKEWISE, THE OTHER MEMBER MUST ALSO FILL UP
ANOTHER ARREST AND BOOKING FORM NAMING THE OTHER MEMBER OF THE TEAM AS THE PERSON
ARRESTED AND HE/SHE ACTING AS THE ARRESTING OFFICER. THE FORMS MUST BE SUBMITTED ON OR
BEFORE THE SUBMISSION DATE,

SUBMISSION DATE: MONDAY OCTOBER 18, 2022 11:59PM

EMAIL ADDRESS: [email protected]
NOTE: USE ONLY 1 FILE FOR THE SUBMISSION OF THE 2 ACTIVITIES.
Sample Format of Complaint Sheet (Other Crimes)

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
NAVOTAS POLICE DISTRICT
_______________________

COMPLAINT SHEET

Complaint No. 0123 Date: March

24, 2021

1. REPORTED THThru 2. Previously Reported to other agency:

[ ✔️] In Person [ ] Yes [✔️] No
[ ] Telephone If yes;
[ ] Other a. To what agency
_____________________________
b. BY whom
__________________________________
c. Date/time
__________________________________

3. Nature of Complaint/Info 4. Place of Occurrence/Incident 5. Date/time

In front of 77 Bagong Kalsada March 23,

St. Tangos Navotas City 2021 at
1:00 am

6. Name of Complainant/Informer 7. Address 8. Tel No.

Leo B. Agan Resident of 77 Bagong
Kalsada St. Tangos Navotas N/A
City

9. Name(s) of Victim(s) 10. Age 11.Sex 12. Address 13. Tel No.

Khim S. Agan 25 Male Resident of 77 N/A

years Bagong Kalsada St.
old Tangos Navotas City
14. Name(s) of Suspect(s) 15. Alias 16.Sex 17.Age 18. Address

Paul Guerrero Pao-pao Male 28 Resident of 52 A.

years Santiago St. Sipac
old Almacen Navotas
City
19. Name(s) of Witness(es) 20. Address 21. Tel No.
Resident of 79 Bagong
Joy R. Sevilla
Kalsada St. Tangos N/A
Navotas City
22. Brief facts/narrative of complaint (Use back page, if necessary)

Facts of the Case; At about 0100, March 23rd, 2020, A dispute has transpired,
involving Khim Agan and Paul Guerrero, resulting the suspect to repeatedly stab the victim
that caused his immediate death. The motive behind the incident was because of jealousy.
The investigation made had disclosed that the victim, Khim Agan, was on his way home
from his work and when near the front of his home when Paul Guerrero suddenly appeared.
Paul Guerrero was suspected to be under the influence of alcohol. Eventually, after Paul
Guerrero successfully killed Khim Agan, he ran immediately and dropped-off the weapon
that is used for killing. The victim died because of massive blood loss because of the multiple
stab wound that he received from the suspect.
At about 9:52 AM of March 24, 2020, the witness/complainant personally appeared to
this office to give his statement and to file complaint against the suspect Paul Guerrero,
hence this case.

Investigator-on-case: SPO1 DONITA BERNARDINO

23. Remarks of the receiving officer (especially if reporter refused to be identified):

a. Dialect (Accent): Tagalog

b. Female/Male: Male
c. Possible Age: 28 years Old
d. Possible place where the caller is: Navotas City
e. Intoxicated or not: Yes
f. Others: Alcoholic

24. I certify that the details of the 25. SUBSCRIBED AND SWORN to before
complaint/info stated above are true and me this 24th day of April 2021 at Camp
correct to the best of my knowledge. Crame, Navotas City.

Joy S. Sevilla
Printed Name & Signature of Complainant/Informer
26. Date/Time/Complaint/Info Received 27. Printed name/Signature of Receiving
Officer
March 24, 2020 at 9:52 am
PO3 Renzel Regualos

28. Assigned to: 29. Noted by:

SPO1 DONITA BERNARDINO SPO3 RONEL CALLEDO

CONFIDENTIAL
 Sample Format of Alarm Sheet (Carnapping Incident)

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
Northern Police District

Date: October 18, 2021

COMPLAINT SHEET

Name of Suspects: Pablo Escobar

Last Known Address:Brgy 35 Pasig St. Pajo Caloocan City
Place Where Offense was Committed: In front of Mercury Drug Pajo Caloocan City

Date/Time Offense was Committed: October 18, 2021 11:00pm (Tuesday)

Local Police Office First Reported:Northern Police District

Date Reported: October 18, 2021

Witness: Renejay Kelra (Tusok Tusok Vendor)

ALARM SHEET
Alarm No. Date Reported Time Reported Date Lost Time Lost
00001-2021 10-18-21 11:30 P.M. 10-18-21 11:00P.M.

MOTOR VEHICLE DESCRIPTION

Make Series Year Model Body Type
Honda XR200 2012
[ ] AUV [ ] Jeepney [ ] HSPUR
Classification Engine No. [ ] Car [ ] Bus [ ] 3 Wheeled
[✔️] Private KCN0303Z001857E [ ] Wagon [ ] Utility Van [✔️] Motorcycle
[ ] For Hire [ ] Pick Up [ ] Truck [ ] Others:
[ ] Government [ ] Closed Van [ ] Dropside ___________
[ ] Diplomat Chassis No.
KCN0303Z001857

Plate No. Color MV File No. MVRR No. CR No.

352NFI Red/Gold 0444-00000075744 N/A 000000015676148

OWNER DESCRIPTION
Registered Owner Last Name First Name Middle Name Telephone No. 09565391760
Calledo Ronel Land Line # N/A
Briones Mobile # 09565391760
Address Type of ID presented ID Number presented
Blk 1 Lot 1P Phase lll E1 Kaunlaran Village Caloocan City Driver's licence 20181157

Insurer Tel No. Classification

N/A N/A [✔️] TPL
[ ] Comprehensive
CIRCUMSTANCES
Mode of Loss Brief Narration
[ ] Seized at Gunpoint/Intimidation
[✔️] Seized While Parked Unattended
[ ] Qualified Theft On October 18,2021, at 11:00p.m.,while owner Ronel Calledo
[] Theft was a security guard on his way home after duty, he parked his
[ ] Fraud
[ ] Estafa
motorcycle in front of the tusok tusok store across the street.
[ ] Others _______________________
His motorcycle was nowhere to be found when he returned.
Place of Offense Committed: [ ] WITH SAFETY DEVICE [ ] ACTIVATED
In front of Mercury Drug's Pajo Caloocan City [ ] NOT ACTIVATED [ ] MANUAL [ ] ELECTRONIC
[ ] GSP [✔️] WITHOUT SAFETY DEVICE

Reported By: PO1 Donita Bernardino

_________________________________________________________

Investigated By: PO2 Kurt Sales 2x3

Picture
_________________________________________________________ With signature and
Thumb mark
_________________________________________________________

Approved By: PCOL. Paul Grate

CERTIFICATION

I, RONEL B. CALLEDO , after having been duly sworn to in accordance to law

do hereby depose and say:
That I am the complainant of the aforesaid complaint;
That I have read the essence and signed the same;
That all the allegations contained herein are true and correct to the best of my
knowledge and hereby warrant under penalty of perjury and;
That I will immediately inform the PNP-HPG in case the above described motor
vehicle is recovered (by us) so that alarm could be lifted.

Conformed By: Ronel B. Calledo

(Registered Owner) (Driver)

Address:Blk 1 Lot 1P Phase lll E1 Kaunlaran Village Caloocan

City
Tel/Cell No. 09565391760
 SUBSCRIBED AND SWORN to before me this 18th day of October 2021,
affiant exhibited to me his/her Residence Certificate No. 0004359-233 issued at 1:00pm
on Northern Police District Office

1186-28-200
(Notary Public)

Note: Person found guilty of perjury is liable under Art. 183 of the Revised Penal
Code.

ACTIVITY FOR: WARRANT OF ARREST AND SEARCH WARRANT

PNP BOOKING FORM 2 – “Arrest and Booking Form”

Republic of the Philippines

Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
 ________________________________
_____________________
Picture
2x2 PNP ARREST AND BOOKING SHEET
FRONT VIEW (to be accomplished by the Arresting Officer)

BLOTTER ENTRY NR: ____________ DATE: October 18,2021

PERSONAL INFORMATION:
Calledo Ronel Briones
(Last Name) (First Name) (Middle Name)
ADDRESS: Blk 1 Lot1P Phase lll E1 Pampano St. Dagatdagatan Caloocan City
TEL NO. NONE_ POB Looc, Occidental Mindoro_ DOB December 18,1999
MARITAL STATUS: ✔️SINGLE WIDOW/ER SEX: ✔️MALE
MARRIED SEPARATED FEMALE
AGE: 20 WEIGHT (lbs): 62kg HEIGHT (Ft): 5’7” EYES: Black_ HAIR: Black
COMPLEXION: Brown OCCUPATION: Office Staff NATIONALITY: Filipino
ETHNIC Group: N/A DIALECT/LANGUAGE: English/Tagalog
HIGHEST EDUCATIONAL ATTAINMENT: Vocational Course Graduate
NAME OF SCHOOL: Don Bosco TVET Center Tondo
LOCATION OF SCHOOL: P Garcia Tondo Manila
IDENTIFYING MARKS: MOLE ✔️TATOO BIRTHMARK SCAR
LOCATION OF IDENTIFYING Marks Rigt Arm
PHYSICAL DEFORMITY/DEFECT NONE
DRIVER’S LIC NR: A00-88-123456 ISSUED AT: Manila South District Office ON: January
12, 2016
RES CERT NR: N/A DATE AND PLACE OF ISSUE: January 12,2016 At Manila South District
Office
OTHER ID CARDS: UMID ID NR: 0111-4571867-6
ARREST INFORMATION:
OFFENSE CHARGE:
RECKLESS IMPRUDENCE RESULTING IN DAMAGE TO PROPERTY 2021-C12345
(NATURE OF OFFENSE) (CRIM/IS NO.)
MODUS OPERANDA:_______________________________________________________________
WHERE ARRESTED: C3 Dagatdagatan Caloocan City
DATE ARRESTED: October 18, 2021 TIME: 11:20am
ARRESTING OFFICER/S:
Rank: PO1 Name: DONITA BERNARDINO Signature:
Rank:________Name:______________________________Signature:_____________________
Rank:________Name:______________________________Signature:_____________________
SIGNATURE___________________________________ UNIT: Northern Police District

MEDICAL EXAMINATION CONDUCTED AT: Manila Naval Hospital

BY: DR. Dexie Grate ON: October 18,2021 at 3:00pm
REMARKS:_____________________________________________________________________
FINGERPRINT TAKEN BY: PO1 KURT SALES
PHOTO TAKEN BY: PO1 ALLAN JOCSON
INVESTIGATOR ON CASE: PO1 DONITA BERNARDINO
BOOKED BY (RANK/NAME/SIGNATURE): PO2 CARDO DALISAY
SIGNATURE OF PERSON ARRESTED:
(INDICATE IF SUSPECT REFUSE TO SIGN)
OTHER INFORMATION:
NAME OF FATHER: Helcurt Calledo AGE: 45
ADDRESS: BLK 1 Lot 1P Phase lll E1 Pampano St. Dagatdagatan Caloocan City
NAME OF MOTHER:Aurora Calledo AGE: 43
ADDRESS: BLK 1 Lot 1P Phase lll E1 Pampano St. Dagatdagatan Caloocan City
NAME & ADDRESS OF PERSON TO BE CONTACTED IN CASE OF EMERGENCY:
NAME: Helcurt Calledo RELATIONSHIP: Father
ADDRESS: BLK 1 Lot 1P Phase lll E1 Pampano St. Dagatdagatan Caloocan City TEL #
LAWYER: N/A TEL #: N/A
DOCTOR: N/A TEL #: N/A
HEALTH PROBLEM: N/A

NOTE: USE THE PNPCL FORM 452-038 (STANDARD TEN PRINT CARD) TO TAKE THE TENPRINT
OF THE SUSPECT FOR EVENTUAL SUBMISSION TO PNPCL-AFIS

(ATTACH THE MEDICAL EXAM RESULT; MUG SHOTS; TENPRINTS OF SUSPECT)

PNP BOOKING FORM 2 – “Arrest and Booking Form”

Republic of the Philippines

 Department of the Interior and Local GGGovernment
PHILIPPINE NATIONAL POLICE
______________________
_______________________
Picture
2x2 PNP ARREST AND BOOKING SHEET
FRONT VIEW (to be accomplished by the Arresting Officer)

BLOTTER ENTRY NR: ____________ DATE: October 17,2021

PERSONAL INFORMATION:
Bernardino Donita Atienza
(Last Name) (First Name) (Middle Name)
ADDRESS: 81 Bagong Kalsada St. Tangos Navotas city
TEL NO. N/A POB Tangos Navotas City DOB September 03,2021
MARITAL STATUS: ✔️SINGLE WIDOW/ER SEX: MALE
MARRIED SEPARATED ✔️FEMALE
AGE: 23 Weight (kg): 47kg HEIGHT (Ft): 5'5" EYES: Black HAIR: Black
COMPLEXION: Brown OCCUPATION: Office Staff NATIONALITY:Filipino
ETHNIC Group: N/A DIALECT/LANGUAGE : English / Tagalog
HIGHEST EDUCATIONAL ATTAINMENT: College Graduate
NAME OF SCHOOL: Navotas Polytechnic College
LOCATION OF SCHOOL: Navotas City
IDENTIFYING MARKS: MOLE TATOO ✔️BIRTHMARK SCAR
LOCATION OF IDENTIFYING MARKS: Left Arm
PHYSICAL DEFORMITY/DEFECT: N/A
DRIVER’S LIC NR: A00-77- 654321 ISSUED AT: Manila South District Office ON: Feb 14, 2017
RES CERT NR: N/A DATE AND PLACE OF ISSUE: February 14, 2017 Manila South District
OTHER ID CARDS: UMID ID NR: 0111-45637779
ARREST INFORMATION:
OFFENSE CHARGE: Qualified Theft 2021-C54321
(NATURE OF OFFENSE) (CRIM/IS NO.)
MODUS OPERANDA: N/A
WHERE ARRESTED: San Roque Shipyard Navotas
DATE ARRESTED: October 17, 2021 TIME: 4:00pm
ARRESTING OFFICER/S:
Rank: PO1 Name: Ronel Calledo Signature:
Rank:________Name:______________________________Signature:_____________________
Rank:________Name:______________________________Signature:_____________________
Signature UNIT: Navotas Police District

MEDICAL EXAMINATION CONDUCTED AT:Manila Naval Hospital

BY: DR. Gringo Canals ON: October 17, 2021 5:30pm
REMARKS:N/A
FINGERPRINT TAKEN BY: PO1 JERSON POMAR
PHOTO TAKEN BY: PO1 JEREMY FUERTES
INVESTIGATOR ON CASE: PO1 RONEL CALLEDO
BOOKED BY (RANK/NAME/SIGNATURE): PO2 STEVE MARTIN
SIGNATURE OF PERSON ARRESTED:
(INDICATE IF SUSPECT REFUSE TO SIGN)
OTHER INFORMATION:
NAME OF FATHER: Gusion Bernardino AGE: 35
ADDRESS: 81 Bagong Kalsada St. Navotas City
NAME OF MOTHER: Vexana Bernardino AGE: 30
ADDRESS: 81 Bagong Kalsada St. Navotas City
NAME & ADDRESS OF PERSON TO BE CONTACTED IN CASE OF EMERGENCY:
NAME: Gusion Bernardino RELATIONSHIP: Father
ADDRESS:81 Bagong Kalsada St. Navotas City TEL #:N/A
LAWYER: N/A TEL #:N/A
DOCTOR: N/A TEL #:N/A
HEALTH PROBLEM: N/A

NOTE: USE THE PNPCL FORM 452-038 (STANDARD TEN PRINT CARD) TO TAKE THE TENPRINT
OF THE SUSPECT FOR EVENTUAL SUBMISSION TO PNPCL-AFIS

(ATTACH THE MEDICAL EXAM RESULT; MUG SHOTS; TENPRINTS OF SUSPECT)