Philippine National Police
INCIDENT RECORD FORM
IRF ENTRY NUMBER:
TYPE OF INCIDENT:
COPY FOR:
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:
ITEM A - REPORTING PERSON
FAMILY NAME
CITIZENSHIP
FIRST NAME
SEX/GENDER
CIVIL STATUS
DATE OF BIRTH (MM/DD/YY)
MIDDLE NAME
AGE
PLACE OF BIRTH
QUALIFIER
NICKNAME
HOME PHONE
MOBILE PHONE
CURRENT ADDRESS (HOUSE NUMBER/STREET)
VILLAGE/SITIO
BARANGAY
TOWN/CITY
PROVINCE
OTHER ADDRESS (HOUSE NUMBER/STREET)
VILLAGE/SITIO
BARANGAY
TOWN/CITY
PROVINCE
HIGHEST EDUCATIONAL ATTAINMENT
OCCUPATION
ID CARD PRESENTED
EMAIL ADDRESS (If Any)
ITEM B SUSPECTS DATA
FAMILY NAME
CITIZENSHIP
FIRST NAME
SEX/GENDER
CIVIL STATUS
DATE OF BIRTH (MM/DD/YY)
MIDDLE NAME
AGE
PLACE OF BIRTH
QUALIFIER
NICKNAME
HOME PHONE
MOBILE PHONE
CURRENT ADDRESS (HOUSE NUMBER/STREET)
VILLAGE/SITIO
BARANGAY
TOWN/CITY
PROVINCE
OTHER ADDRESS (HOUSE NUMBER/STREET)
VILLAGE/SITIO
BARANGAY
TOWN/CITY
PROVINCE
RELATION TO
VICTIM
EMAIL ADDRESS (If Any)
HIGHEST EDUCATIONAL ATTAINMENT
OCCUPATION
IF AFP/PNP PERSONNEL: RANK
UNIT ASSIGNMENT
GROUP AFFILIATION
HEIGHT
COLOR OF EYES
DESCRIPTION OF EYES
WEIGHT
BUILT
WORK ADDRESS
WITH PREVIOUS CRIMINAL RECORD?
[ ] Yes [ ] No
(If Yes, Pls. Specify)
COLOR OF HAIR
STATUS OF PREVIOUS CASE
DESCRIPTION OF HAIR
UNDER THE INFLUENCE?
NO DRUGS LIQUOR
OTHERS
________________________
FOR CHILDREN IN CONFLICT WITH THE LAW
NAME OF GUARDIAN
GUARDIAN ADDRESS
HOME PHONE
MOBILE PHONE
ITEM C VICTIMS DATA
FAMILY NAME
CITIZENSHIP
FIRST NAME
SEX/GENDER
CIVIL STATUS
DATE OF BIRTH (MM/DD/YY)
MIDDLE NAME
AGE
PLACE OF BIRTH
QUALIFIER
NICKNAME
HOME PHONE
MOBILE PHONE
CURRENT ADDRESS (HOUSE NUMBER/STREET)
VILLAGE/SITIO
BARANGAY
TOWN/CITY
PROVINCE
OTHER ADDRESS (HOUSE NUMBER/STREET)
VILLAGE/SITIO
BARANGAY
TOWN/CITY
PROVINCE
HIGHEST EDUCATIONAL ATTAINMENT
OCCUPATION
WORK ADDRESS
EMAIL ADDRESS (If Any)
ITEM D - NARRATIVE OF INCIDENT
TYPE OF INCIDENT
DATE/TIME OF INCIDENT
PLACE OF INCIDENT
ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING.
(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE BLOTTER)
NAME OF REPORTING PERSON
SIGNATURE OF REPORTING PERSON
I HEREBY CERTIFY TO THE CORRECTNESS OF
THE FOREGOING TO THE BEST OF MY
KNOWLEDGE AND BELIEF.
NAME OF ADMINISTERING OFFICER (DUTY OFFICER)
SIGNATURE OF ADMINISTERING OFFICER (DUTY OFFICER)
SUBSCRIBED AND SWORN TO BEFORE ME
RANK, NAME AND DESIGNATION OF POLICE OFFICER (WHETHER HE/SHE IS THE DUTY INVESTIGATOR,
INVESTIGATOR ON CASE OR THE ASSISTING POLICE OFFICER)
RANK/NAME OF DESK OFFICER:
SIGNATURE OF DUTY INVESTIGATOR/INVESTIGATOR ON CASE/ASSISTING
POLICE OFFICER
SIGNATURE OF DESK OFFICER:
BLOTTER ENTRY NR:
INCIDENT RECORDED IN THE BLOTTER BY:
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 Station
Telephone
Investigator-on-Case
Mobile Phone
Name of Chief/Head of
Office
Mobile Phone
