FOR POLICE BLOTTER ENCODER

USE ONLY Philippine National Police

BLOTTER ENTRY NUMBER:
01-1234

TYPE OF INCIDENT: (Incident)

INCIDENT RECORD FORM
Stabbing
ROBBERY WITH HOMICIDE
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 DATE AND TIME OF
REPORTED:
2023-09-13 09:00:00
INCIDENT:
2023-09-13 08:50:00
ITEM “A” - REPORTING PERSON
FAMILY NAME: FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
MARTIN COCO

CITIZENSHIP SEX/ CIVIL DATE OF BIRTH AGE PLACE OF BIRTH HOME MOBILE PHONE
FILIPINO GENDER STATUS (DD/MM/YY) 20 ZAMBOANGA CITY PHONE 09876543221
M Single 14 MAY 2003
CURRENT ADDRESS (HOUSE VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
NUMBER/STREET) DIVISORIA ZAMBOANGA ZAMBOANGA DEL
LUMIYAP ROAD, PEREZ DRIVE CITY SUR
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

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

ITEM “B” - SUSPECT DATA

 CHECK HERE IF THERE IS NO SUSPECT INVOLVED AND THEREAFTER PROCEED TO ITEM “C”.
 CHECK HERE IF THERE ARE TWO OR MORE SUSPECTS. THEREAFTER, USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR EACH OF THE SUSPECTS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
REYES LAVERNA
CITIZENSHIP SEX/ CIVIL DATE OF BIRTH AGE PLACE OF BIRTH HOME MOBILE PHONE
FILIPINO GENDER STATUS (DD/MM/YY) 32 LABUAN ZAMBOANGA CITY PHONE 09346521765
F WIDOW 23 MAY 1991
CURRENT ADDRESS (HOUSE VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
NUMBER/STREET) LABUAN ZAMBOANGA CITY ZAMBOANGA DEL
LAWINGAN SUR
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL OCCUPATION WORK ADDRESS RELATION TO EMAIL ADDRESS (If

ATTAINMENT JANITOR BALIWASAN ZAMBOANGA CITY VICTIM Any)
HIGHSCHOOL COLLEAGUE
IF AFP/PNP UNIT ASSIGNMENT GROUP WITH PREVIOUS CRIMINAL RECORD? STATUS OF PREVIOUS CASE
PERSONNEL: RANK AFFILIATION [/] Yes [ ] No CONVICTED AND SERVED
(If Yes, Pls. Specify) SENTENCE
THEFT (MALL INCIDENT) - 2019
HEIGHT WEIGHT COLOR OF DESCRIPTION OF COLOR OF DESCRIPTION OF HAIR UNDER THE INFLUENCE?
EYES EYES HAIR  NO  DRUGS  LIQUOR
 OTHERS

FOR CHILDREN IN CONFLICT WITH THE

LAW
NAME OF GUARDIAN GUARDIAN ADDRESS HOME PHONE MOBILE PHONE

ITEM “C” – VICTIM DATA

 CHECK HERE IF THE REPORTING PERSON (ITEM “A”) IS THE VICTIM. PROCEED TO ITEM “D”.
 CHECK HERE IF THERE ARE TWO OR MORE VICTIMS. USE ADDITIONAL INCIDENT REPORT FORM SHEETS FOR THE DATA OF THE ADDITIONAL VICTIMS.
FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIE NICKNAME
MADRAZO ALEXIS GABRIEL ACABO R
CITIZENSHIP SEX/ CIVIL DATE OF BIRTH AGE PLACE OF BIRTH HOME PHONE MOBILE
FILIPINO GENDER STATUS (DD/MM/YY) 19 ZAMBOANGA CITY PHONE
M Single 27 APRIL 2004 09123456789
CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
FELISARIO DRIVE DIVISORIA ZAMBOANGA CITY ZAMBOANGA DEL
SUR
OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

HIGHEST EDUCATIONAL OCCUPATION WORK ADDRESS EMAIL ADDRESS (If

ATTAINMENT PROFESSOR BALIWASAN ZAMBOANGA CITY Any)
COLLEGE
 ITEM “D” - NARRATIVE OF INCIDENT
BLOTTER ENTRY NUMBER TYPE OF INCIDENT TIME DATE PLACE OF INCIDENT
01-1234 ROBBERY WITH HOMICIDE 09:00:00 13 NOV 2023 WMSU, CSM BUILDING, CSM
109 LAB ROOM, NORMAL ROAD,
BALIWASAN ZAMBOANGA CITY
ENTER IN DETAIL THE NARRATIVE OF THE INCIDENT OR EVENT, ANSWERING THE WHO, WHAT, WHEN, WHERE, WHY AND HOW OF REPORTING. (USE ADDITIONAL SHEET/S IF NECESSARY)

On the morning of November 13, 2023, at approximately 8:50 am, an incident was reported at Baliwasan Police Substation. The SOCO
team, led by Officer Sean Justin M. Caloyloy, arrived at the scene at 9:00 am, following the report. Upon arrival, Officer Caloyloy
discovered the lifeless body of the victim, identified as Alexis Madrazo, lying on the floor in CSM 109 Lab Room. The victim had
sustained multiple stab wounds to the stomach. The crime scene also contained evidentiary items, including the victim's wallet,
cellphone, a hair strand near the victim's hand, and a scissor with traces of blood. The victim's wallet contained identification,
confirming the victim's identity. According to the initial assessment, it appears that the incident is a potential case of Robbery with
Homicide. The assailant seems to have confronted the victim during the theft of the victim's wallet, leading to a violent altercation
resulting in the victim's death. A trail of blood droplets leading out of the scene suggests a potential struggle with an unidentified
suspect. The first responder promptly cordoned off the area to preserve the integrity of the crime scene. Preliminary assessment and
documentation, including photographing, sketching, and measuring of the crime scene, were carried out. Evidentiary items were
carefully identified and documented for further analysis. The "who" aspect remains unknown at this stage, as the identity of the
suspect is yet to be determined. The investigation is ongoing to establish the motive, identity, and sequence of events leading to this
tragic incident. Further analysis, forensic examination, and witness interviews will be crucial in unraveling the details of this potential
Robbery with Homicide.

(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE POLICE
BLOTTER)
AUTHENTICATION
I HEREBY CERTIFY TO THE CORRECTNESS OF THE NAME/SIGNATURE OF REPORTING PERSON NAME/SIGNATURE OF DESK OFFICER
FOREGOING TO THE BEST OF MY KNOWLEDGE AND
BELIEF.

CASE DISPOSITION (For Chief/Head of Office Use Only)

CHIEF Of STATION/OFFICE INSTRUCTIONS NAME OF DESIGNATED INVESTIGATOR-ON-CASE NAME OF CHIEF OF STATION/OFFICE

-----------------------------CUT HERE--------------------------------------------------------------------------------------CUT HERE------------------------------------------------------

INSTRUCTIONS TO REPORTING PERSON
Keep this Incident Record Transaction Receipt (IRTR). 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 IRTR. 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
Mobile Phone
Office