Republic of the Philippines
NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE
FORENSIC GROUP
Camp BGen Rafael T Crame, Quezon City
QUESTIONED DOCUMENT EXAMINATION DIVISION
Email: pnpcl_qded@yahoo.com
INSTRUCTION: Please use BLACK pen in filling-out this form. Put NONE if not applicable. Don’t leave blank.
___________________
Date
FAMILY NAME GIVEN NAME MIDDLE NAME NICKNAME Qualifier
PERMANENT ADDRESS: ___________________________________________________________________________________
STREET BRGY MUNICIPALITY/TOWN PROVINCE
PRESENT ADDRESS: _____________________________________________________________________________________
STREET BRGY MUNICIPALITY/TOWN PROVINCE
DATE OF BIRTH: ________________________PLACE OF BIRTH: ____________________________________ AGE: ________
NATIONALITY: ________________________________________CIVIL STATUS_______________________________________
LAST SCHOOL ATTENDED _________________________________ADDRESS OF SCHOOL____________________________
DEGREE: ________________________________HIGHEST EDUCATIONAL ATTAINMENT______________________________
PRESENT OCCUPATION: ______________________________ MOTHERS MAIDEN NAME _____________________________
SPOUSE’s NAME _____________________________________OCCUPATION OF SPOUSE _____________________________
CONTACT PERSON IN CASE OF EMERGENCY ________________________________________________________________
PRESENT ADDRESS: ________________________________________ CONTACT NUMBER____________________________
WRITE ALL THE LETTERS OF THE ALPHABET
1. Small letters in (long hand)_________________________________________________________________________________
________________________________________________________________________________________________________
2. Small letters in (script writing) ______________________________________________________________________________
________________________________________________________________________________________________________
3. Capital letters in (long hand) _______________________________________________________________________________
________________________________________________________________________________________________________
4. Capital letters in (block writing) _____________________________________________________________________________
________________________________________________________________________________________________________
5. Write number from (0 to 9) and punctuation____________________________________________________________________
HANDWRITING
1. Name in (long hand):_____________________________________________________________________________________
2. Name in (block writing): ___________________________________________________________________________________
3. Did you write with your left or right hand? _____________________________________________________________________
Not to be reproduced or photocopied without prior authorization from the FG Top Management
INSTRUCTION: COPY EXACTLY IN YOUR OWN HANDWRITING THE WHOLE PARAGRAPH BELOW
..……………………………………………………………………………………………………………………………
As Leonardo Luis E. Rapazo III in 105th Xavier guzzled his way through, three (3) bottles of brandy.
Mary Josephine Z. Quinzing, a partner in the Quezon City turned to John Richard Dick Ting Sr., a Chinese
food expert from Q.C. Kuantong Company Ltd. 346 Hadji Jairula Hussein Blvd., and said: I can’t speak for
my government but I’m quite sure your Company and mine better get together for closer understanding.
I HEREBY CERTIFY that the above data are true and correct and that the writing appearing hereon are
my true and genuine handwriting.
_____________________________
(Signature)
_____________________________
(Signature)
SUBSCRIBED AND SWORN to before me this______ day of____________20______at _________________________
_________________________________________________________________.
..………………………………………………………………………………………………………………………………………...
FOR FORENSIC GROUP PERSONNEL ONLY.
Prepared in the presence of 1) _________________________________________________________
Signature over printed name
2) _______________________________________________________________
Signature over printed name
RIGHT HAND THUMBMARK
WARNING: FALSIFICATION IS CRIMINAL OFFENSE AND PUNISHABLE UNDER THE REVISED PENAL CODE.
NOTE: A Copy of this document is retained by Questioned Document Examination Division for record and
reference.
Not to be reproduced or photocopied without prior authorization from the FG Top Management
