Philippine National Police

INCIDENT RECORD FORM

IRF ENTRY NUMBER: TYPE OF INCIDENT: COPY FOR:

6 Robbery
INSTRUCTIONS: Refer to PNP SOP on ‘Recording of Incidents in the Police Blotter’ in filling up this form. This Incident Record Form (IRF) may be
reproduced, photocopied, and/or downloaded from the DIDM website, www.didm.pnp.gov.ph.
DATE AND TIME REPORTED: DATE AND TIME OF INCIDENT: PLACE OF INCIDENT:
March 12, 2014/ 10:40 p.m. March 12, 2014/ 10:00 p.m. Tubod,Iligan City

ITEM “A” - REPORTING PERSON

FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME

Reyes Jesus Romano Jess

CITIZENSHIP SEX/GENDER CIVILSTATUS DATE OF BIRTH AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
Filipino Male Single November 1, 1994 24 Tipanoy, Iligan City 09275357407

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

San Juan St. Tipanoy Iligan

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION ID CARD EMAIL ADDRESS (If Any)

High School Graduate Security Guard PRESENTED
Company Id
ITEM “B” – SUSPECT’S DATA

FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME

Bato John Tugas Totoy
CITIZENSHIP SEX/GENDER CIVIL DATE OF BIRTH AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
Filipino Male STATUS October 1, 1998 20 Tominobo, Iligan City 09261333841
Single
CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
San Miguel St. Tominobo Iligan
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS RELATION TO EMAIL ADDRESS (If Any)
High School Graduate None None VICTIM
None
IF AFP/PNP PERSONNEL: RANK UNIT GROUP AFFILIATION WITH PREVIOUS CRIMINAL STATUS OF PREVIOUS CASE
ASSIGNMENT RECORD?
[ ] Yes [ ] No
(If Yes, Pls. Specify)

HEIGHT WEIGHT BUILT COLOR OF EYES DESCRIPTION OF COLOR OF HAIR DESCRIPTION OF UNDER THE INFLUENCE?
162 cm 60 kg medium black EYES black HAIR NO DRUGS LIQUOR
black Straight OTHERS
________________________
FOR CHILDREN IN CONFLICT WITH THE LAW

NAME OF GUARDIAN GUARDIAN ADDRESS HOME PHONE MOBILE PHONE

 ITEM “C” – VICTIM’S DATA

FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME

Smith Brad Green

CITIZENSHIP SEX/GENDERCIVIL DATE OF BIRTH AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
Australian Male STATUS July 2, 1979 40 Broome, Australia 09263458765
Married
CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
Dona Maria Tipanoy Iligan

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)
College graduate Businessman Tubod, Iligan City

ITEM “D” - NARRATIVE OF INCIDENT

TYPE OF INCIDENT DATE/TIME OF INCIDENT PLACE OF INCIDENT

Theft March 12,2014 Go Hotel, Iligan City

ENTER IN DETAIL OF THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING.

One Jesus Reyes y Romano, Filipino, single, 24 years old , a security officer and a resident of San Juan St., Barangay Tipanoy, Iligan City personally came to
this office ( Station 4) at around 10:40 in the evening of March 12, 2014 and reported that around 10:00 in the evening of March 12,2014 , while
conducting their patrol at the beach front of Shangrila Hotel in Barangay Manoc- Manoc, Boracay Island, Caticlan , he and his fellow security officer
noticed two male persons sneaking out of the window from one of the rooms at the 2 nd floor of the said hotel. When he and his fellow security officer
called out the attention of the two suspicious person, they immediately run that’s why he and his fellow security officer chased them. After a brief chase ,
the suspects were arrested and identified as John Bato and Peter Darak and confiscated from their possession some cell phones, wallet, digital camera,
and a cash amounting to Php 150,000. It was found out that the owner of the stolen items were a certain Brad Smith and Jolina Smith.

(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)
I HEREBY CERTIFY TO THE CORRECTNESS OF NAME OF REPORTING PERSON SIGNATURE OF REPORTING PERSON
THE FOREGOING TO THE BEST OF MY Jesus R. Reyes
KNOWLEDGE AND BELIEF.
NAME OF ADMINISTERING OFFICER SIGNATURE OF ADMINISTERING OFFICER (DUTY OFFICER)
(DUTY OFFICER)
SUBSCRIBED AND SWORN TO BEFORE ME Pcpt Aiman Khuzaimah Pantaran

RANK, NAME AND DESIGNATION OF POLICE OFFICER (WHETHER HE/SHE IS THE DUTY SIGNATURE OF DUTY INVESTIGATOR/INVESTIGATOR ON
INVESTIGATOR, INVESTIGATOR ON CASE OR THE ASSISTING POLICE OFFICER) CASE/ASSISTING POLICE OFFICER

RANK/NAME OF DESK OFFICER: SIGNATURE OF DESK BLOTTER ENTRY NR:

INCIDENT RECORDED IN THE BLOTTER BY: Pat Ritchie A. Calo OFFICER: 6

REMINDER TO REPORTING PERSON

Keep the copy of this Incident Record Form (IRF). An update of the progress of the investigation of the crime or incident that you reported
will be given to you upon presentation of this IRF. For your reference, the data below is the contact details of this police station.

Name of Police Iligan City Police Station 4 Telephone 162

Station
Investigator-on-Case Pat Edward Sinon Mobile Phone

Name of Chief/Head
PCPT AimanKhuzaimahPantaran Mobile Phone
of Office