Republic of the Philippines
Department of the Interior and Local Government
PHILIPPINE NATIONAL POLICE
PHILIPPINE NATIONAL POLICE PROVINCIAL OFFICE 1
Pasuquin Municipal Police Station
PNP ARREST AND BOOKING SHEET
(to be accomplished by the Arresting Officer)
BLOTTER ENTRY NR: 2021-0001 DATE:
PERSONAL INFORMATION
(Last Name) (First Name) (Middle Name)
ADDRESS:
TEL NO: 09636761200 POB: DOB:
MARITAL STATUS: SINGLE WIDOW/ER SEX: MALE
MARRIED SEPARATED FEMALE
AGE: _____ WEIGHT (lbs): __________HEIGHT (Ft): ________EYES:HAIR:_________
COMPLEXION: ____________OCCUPATION: ______________NATIONALITY:_________________
ETHNIC GROUP_______________________DIALECT/LANGUAGE__________________
HIGHEST EDUCATIONAL ATTAINMENT: _______________________________________________
NAME OF SCHOOL: ________________________________________________________________
LOCATION OF SCHOOL: ____________________________________________________________
IDENTIFYING MARKS: MOLE TATOO BIRTHMARK SCAR
LOCATION OF IDENTIFYING MARKS__________________________________________________
PHYSICAL DEFORMITY/DEFECT ____________________________________________________
DRIVER’S LIC NR: ________________________ISSUED AT: ______________ ON: _____________
RES CERT NR: __________________ DATE AND PLACE OF ISSUE: ________________________
OTHER ID CARDS: _______________________________________________ID NR: ____________
ARREST INFORMATION:
OFFENSE CHARGE:__________________________________________ ____________________
(NATURE OF OFFENSE) (CRIM/IS NO.)
MODUS OPERANDA:_______________________________________________________________
WHERE ARRESTED: _______________________________________________________________
DATE ARRESTED: ______________________________________ TIME: ____________________
ARRESTING OFFICER/S:
Rank:________Name:______________________________Signature:_____________________
Rank:________Name:______________________________Signature:_____________________
Rank:________Name:______________________________Signature:_____________________
SIGNATURE___________________________________ UNIT: ______________________________
MEDICAL EXAMINATION CONDUCTED AT: ____________________________________________
BY: DR. ___________________________________________________ ON: ___________________
REMARKS:_____________________________________________________________________
FINGERPRINT TAKEN BY: __________________________________________________________
PHOTO TAKEN BY: ________________________________________________________________
INVESTIGATOR ON CASE:___________________________________________________________
BOOKED BY (RANK/NAME/SIGNATURE): ______________________________________________
SIGNATURE OF PERSON ARRESTED: _______________________________________________
(INDICATE IF SUSPECT REFUSE TO SIGN)
OTHER INFORMATION:
NAME OF FATHER: _____________________________________________________ AGE: _____
ADDRESS: _______________________________________________________________________
NAME OF MOTHER: ____________________________________________________ AGE: ______
ADDRESS: _______________________________________________________________________
NAME & ADDRESS OF PERSON TO BE CONTACTED IN CASE OF EMERGENCY:
NAME: __________________________________________________ RELATIONSHIP: _________
ADDRESS: _____________________________________________ TEL # _____________________
LAWYER: _________________________________________ TEL #: _________________________
DOCTOR: _________________________________________ TEL #:_________________________
HEALTH PROBLEM: ________________________________________________________________
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)
