PRE-PAROLE/EXECUTIVE CLEMENCY
INVESTIGATION REPORT
I.
PERSONAL DATA
Prisoner: _____________________________________________ Prison No. __________
(Last Name) (First Name) (Middle Name)
Alias(es): ________________________ Age: _______ Sex: ______ Civil Status: _________
Date of Birth: _________________ Place of Birth:___________________________________
Citizenship: _____________ Religion: ________________ Indent Marks: ________________
Residence prior to NBP Imprisonment: _____________________________________________
Where to Reside after Release: ___________________________________________________
With whom: __________________ Name: _________________________________________
Relationship: _______________________ Occupation: ______________________________
Father’s full name: ______________________________ Occupation: ___________________
Address of Father: ____________________________________________________________
Mother’s full name: ______________________________ Occupation: __________________
Address of Mother: ____________________________________________________________
If married, name of spouse: ___________________________ Occupation: ________________
Status of Marriage: Married ( ) Separated ( ) Live-in/Common Law ( )
Address of Spouse: ___________________________________ Occupation________________
Children:
NAME AGE OCCUPATION
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Family Relationship Major Family Problems
( ) Very Satisfactory ( ) No Apparent Problem
( ) Satisfactory ( ) Economic
( ) Fair ( ) Mental/Physical Illness
( ) Poor ( ) Marital Problem
( ) One-Parent Family
Major Family Problems Family Reputation in the Community
( ) Parent-Child Conflict ( ) Very Satisfactory
( ) Siblings Conflict ( ) Satisfactory
( ) Others ( ) Fair
( ) Poor
Family Economic Status Physical Home Condition
( ) More than Adequate ( ) Very Satisfactory
( ) Adequate ( ) Satisfactory
( ) Inadequate ( ) Fair
( ) Below Poverty Level ( ) Poor
Stability Residence
( ) Stable
( ) Occasional Change
( ) Frequent Change
( ) No Stability
Occupation Prior to imprisonment: _________________________________________________
Work while in Prison if any: ______________________________________________________
Other Employable Skills: ________________________________________________________
Highest Educational Attainment:___________________________________________________
Other Training/s Completed: ______________________________________________________
State of Physical Health but Mental Health shall be determined by Physician/Psychologist of the
Bureau of Corrections:
______________________________________________________________________________
______________________________________________________________________________
II. PRISONER’S CRIMINAL HISTORY
A. PRESENT CRIME IN IMPRISONMENT
Charged with: ______________________________________ Date:______________________
Convicted of: _______________________________________ Date: _____________________
Sentence: _____________________________________________________________________
Judge: __________________________________ Court: _______________________________
Defense Counsel: _____________________________ Address: _________________________
Offended Party: _______________________________ Address: ________________________
Extent of Participation: ( ) Principal ( ) Accomplish ( ) Accessory
Co-Defendants (Names, Disposition, Custody Status):
______________________________________________________________________________
______________________________________________________________________________
Appellate Court: _______________________________________ G.R. No. ________________
Expiration of Sentence with GCTA: MIN. ___________________________________________
MAX. _______________________ Pre-conviction Detention: Inclusive Date: ______________
Total Period:_______________________________
Time Served: _______________________________
Manner of Commission (Narrative):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
B. PRISONER’S VERSION OF THE CASE:
C. OTHER CRIMINAL RECORDS
Agency CC No./Date Offence Disposition Date
NBI __________________ ____________________ __________________
RTC __________________ ____________________ __________________
MTC __________________ ____________________ __________________
PNP __________________ ____________________ __________________
Prosecutor __________________ ____________________ __________________
Barangay __________________ _____________________ __________________
CMRD __________________ _____________________ __________________
BPP’s Previous Action ___________________ __________________ _________________
D. OTHER DEROGATORY INFORMATION (from fellow inmates)
Source/Position Particulars
__________________________________ ___________________________________
__________________________________ ___________________________________
__________________________________ ___________________________________
__________________________________ ___________________________________
__________________________________ ___________________________________
III. INVESTIGATING OFFICER’S COMMENT AND RECOMMENDATIONS
____________________________ Philippines,
____________________________, 2000
Submitted by:
_________________________________
Name and Signature
__________________________________
Position and Designation
REVIEWED AND APPROVED BY:
__________________________________
Name and Signature
_______________________________
Position
Republic of the Philippines
National Crime Information System
Bureau of Corrections
Muntinlupa, Metro Manila
1. Name: Prison No.
Alias:
2. Residence:
Civil Status:
3. Birthday: Birthplace: Age:
4. Occupation:
Religion:
Educational Attainment:
5. OFFENCES:
RAPE
Min. Max.
Total ind:
Criminal Case(s)/ No(s)
6. Court(s):
7. Appealed to the Court of Appeals/Judgement
8. Commencing:
9. Date Received:
10. Credit for Preventive Imprisonment under
11. Expiration of Sentence(s) with GCTA:
Min. Max.
12. Time Served with GCTA:
13. Time to be served with GCTA:
Min: Max:
Time served without GCTA:
Min: Max:
14. Number of previous Convictions:
For what Crime(s):
15. Loss of GCTA: _______________ General Conduct: _____________________
Where Confined: NBP
16. PENDING CASES:
Case No. Cases: Court:
17. Co-accused (Name(s) & Prison No(s).:
18. REMARKS AND RECOMMENDATION
________________________________________________________________________
________________________________________________________________________
Checked by: _____________________________________ File no:_________________
Date: ________________________
Prepared by
______________________________ _____________________________
Chief, Computer Section Chief, Document Section
Republic of the Philippines
Department of Interior and Local Government
BEREAU OF JAIL MANAGEMENT AND PENOLOGY
______________________
Date
NAME: _________________________________ Where Confined _________________
Prison no.________________
Residence: _______________________________________________
Civil Status: _________________ Birth Date: ____________________
Birth Place: __________________________________ Occupation: ________________
Age: ________ Religion: ______________________
Educational Attainment: ____________________________________________________
CRIME/S
________________________________________________________________________
Crim. Case/s No/s: ________________________________________________________
Sentence/s : MIN:___________________________ MAX: _______________________
MIN:___________________________ MAX:________________________
MIN:___________________________ MAX:________________________
Court/s: _________________________________________________________________
Appealed to the Courts of Appeals: ___________________________________________
Judgement:___________________________ Commencing: ______________________
Date Received: _______________________
Credit for preventing imprisonment under RA 6127 ______________________________
Expiration of sentence/s with OCTA (Act No. 3815 a Special Credit Under Act No. 2409)
Min:______________________________ Max:_______________________________
Min:______________________________ Max:________________________________
Time served with OCTA:________________ Years:____________ Months:_________
Days:_____________
No. Of prev. conviction:___________________ For what Crime/s:__________________
Gen. Conduct:____________________________________________________________
Pending case/s (Crime Case/s No/s. & Court/s): _________________________________
Co-accused (Name & Prison No.):____________________________________________
REMARKS AND
RECOMMENDATION:____________________________________________________
________________________________________________________________________
_________________________________
Jail Warden
REPUBLIC OF THE PHILIPPINES
PEOPLE OF THE PHILIPPINES, CRIMINAL CASE NO. ___________
Plaintiff, CRIME: _______________________
-versus-
_____________________________
_____________________________
Accused
--------------------------------------------
TO THE DIRECTOR OF PRISON:
I hereby commit to you the body of
The time of imprisonment will commence to run
From the day of _____ month of _____________
20_____
JUDGE
LETTER HEAD
CERTIFICATION
This to certify that Crime. Case No/s. _________________________________ for
_________________________________________ entitled ______________________________
Was decided by this court on ____________________________; and that the defendant did not
file an appeal/filed an appeal but on _______________________the appeal was dismissed/
withdrawn/ decided with finality.
________________________________
Clerk of court
Republic of the Philippines
Province of Cebu
Cebu Provincial Detention and Rehabilitation Center
OFFICE OF THE PROVINCIAL WARDEN
Cebu City
CERTIFICATE OF DETENTION
TO WHOM IT MAY CONCERN:
This is to certify that as per records available in this office, inmate _______________
has been detained in this Center since to present and convicted in Crim. Case no _____________
For Viol, of Sec. 16, Art. III, R.A 6425 as amended before RTC, 7th Judicial Region, Br., Cebu
City.
This certification is issued upon request of the above-named inmate for his application
of parole.
Cebu City, Philippines.
________________________
Acting Provincial Warden
Republic of the Philippines
Department of the Interior and Local Government
Bureau of Jail Management and Penology Region 7
BAGONG BUHAY REHABILITATION CENTER
Lahug, Cebu City
DETAINEE’S MANIFESTATION
For Republic Act no. 6127
I, _________________________________, _______ years old respectfully makes the following
manifestations:
1. That I an a detention prisoner of Bagong Buhay Rehabilitation Center, charged for
________________________ docketed an Criminal Case No. _____________________
before Branch ________, ___________________________, Cebu City.
2. That I am not a recidivist nor has been convicted twice or more time of any crime.
3. That I have been fully appraised of the conditions, regulations and disciplinary rules
imposed upon convicted prisoners.
4. That I voluntarily agree to abide by said disciplinary rules imposed upon convicted
persons so that I may be given full credit of my preventive imprisonment under the
provisions of R.A. 6127.
In witness whereof, I hereunto sign this instrument this ____ day of ______________
2002 at Bagong Buhay Rehabilitation Center, Lahug, Cebu City.
__________________________
Signature of Detention Prisoner
---------------------------------------------------------------------------------------------------------------------
CERTIFICATION
THIS CERTIFIES that the above-named detention prisoner has manifested his/her
CONFORMITY to abide by the provisions of R.A. 6127, as evidence by his/her signature above.
__________________________
Jail Warden
