Philippine National Police

INCIDENT RECORD FORM

IRF ENTRY NUMBER: TYPE OF INCIDENT: COPY FOR:
2022-021 Shooting Incident

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:
01 December 2022 8 o’clock in the evening 01 December 2022 7:30 in the evening

ITEM “A” - REPORTING PERSON

FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
Sibal Angel Blue Tungcul Abby

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH(MM/DD/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
Filipino Female Single June 18, 2003 19 Sta. Pukaw Memorial Hospital, D’ (241)675-2315) 09531122856
Masapsapulan City
CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE
Sta. Pukaw Street N/A Palao D’Masapsapulan City Cagayan

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

Sta. Nasapulan Street N/A Lannig D’Masapsapulan City Cagayan

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION ID CARD PRESENTED EMAIL ADDRESS (If Any)
Second Year College Student License ID Sibalangelblue2003@gmail.com

ITEM “B” – SUSPECT’S DATA

FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH (MM/DD/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
Filipino Male Single

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

Cagayan

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS RELATION EMAIL ADDRESS (If Any)
TO VICTIM

IF AFP/PNP PERSONNEL: RANK UNIT ASSIGNMENT GROUP AFFILIATION WITH PREVIOUS CRIMINAL STATUS OF PREVIOUS CASE
RECORD?
[ ] Yes [ ] No
(If Yes, Pls. Specify)
HEIGHT WEIGHT BUILT COLOR OF EYES DESCRIPTION OF EYES COLOR OF HAIR 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” – VICTIM’S DATA

FAMILY NAME FIRST NAME MIDDLE NAME QUALIFIER NICKNAME
Garcia Victor Batuelo Bado

CITIZENSHIP SEX/GENDER CIVIL STATUS DATE OF BIRTH(MM/DD/YY) AGE PLACE OF BIRTH HOME PHONE MOBILE PHONE
Filipino Male Single February 29, 1984 38 Arellano Memorial Hospital (276)523-8764) 09617996772

CURRENT ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

Sta. Pukaw St. Sampaguita D’Masapsapulan Cagayan

OTHER ADDRESS (HOUSE NUMBER/STREET) VILLAGE/SITIO BARANGAY TOWN/CITY PROVINCE

Lakandula St. Gen. Balao D’Masapsapulan Cagayan

HIGHEST EDUCATIONAL ATTAINMENT OCCUPATION WORK ADDRESS EMAIL ADDRESS (If Any)
High School Graduate Collector at AKAP Lending Corporation Macapagal City
 ITEM “D” - NARRATIVE OF INCIDENT
TYPE OF INCIDENT DATE/TIME OF INCIDENT PLACE OF INCIDENT
Shooting Incident 1 Dec 2022, 7:30 in the evening Sta. Pukaw St. D’Masapsapulan City

I’m Angel Blue T. Sibal, single, a bonafide resident of Sta. Pukaw Street D' Masapsapulan, a college student of the University of
D' Masapsapulan City, and the owner of the mini grocery.
It was approximately 6:25 in the evening of December 1 when I noticed the suspect roaming around using a black motorcycle
without a plate number in the area where the incident occurred. It so
happened that the victim Victor Batuelo Garcia come home from his work at approximately 7:15 in the evening. The victim went
first to my grocery to buy some foods to eat, but before he buy, he talked first for a while to the people who were hanging out in
front of my store.
At 7:30 in the evening, the victim was about to lend his hand to pay what he buy, when the suspect suddenly came back and was
here to shot the victim twice, the people who are hanging out in front of my store and I was shock and begin to panic. The other
resident in the place was also alarmed when they heard the gunshot sound and they went out to check what happened. When they
saw the victim lying on the ground they start to yell "call the police!!!!!" .The suspect come closer to the victim attempting to
shoot him again but it did not happen again because of the constant yelling of the people seeking for help, so he just took the bag
of the victim and immediately fled with his motorcycle heading toward D’ Masapsapulan and exited to Nasapulan City. The
victim suffered three bullet wounds in his body, one on his thigh and one on his chest.
Moreover when the suspect was already escaped, The resident in the place and I come closer to the victim and this as also the
time that I call the police. after 10 minutes the police arrived with the ambulance .The other resident and I brought the victim to
the nearest hospital at about 8:20 in the evening at JP D'Masapsapulan Memorial Hospital for medical treatment. Other residents
of the area noticed the suspect wearing black clothes and a black hat, which he wore one day while constructing the victim's
cousin's house. People who saw the suspect immediately called the police. The investigation into the identity and whereabouts of
the perpetrators is still ongoing.

(DETAILS OF THIS NARRATIVE SHALL BE THE BASIS IN THE ENTRY OF RECORD IN THE
POLICE BLOTTER)

I HEREBY CERTIFY TO THE NAME OF REPORTING PERSON SIGNATURE OF REPORTING PERSON

Angel Blue T. Sibal
CORRECTNESS OF THE FOREGOING
TO THE BEST OF MY
KNOWLEDGE AND BELIEF.
NAME OF ADMINISTERING OFFICER (DUTY SIGNATURE OF ADMINISTERING OFFICER (DUTY OFFICER)
OFFICER)
SUBSCRIBED AND SWORN TO PO1 Kleyn R. Baltazar
BEFORE ME
RANK, NAME AND DESIGNATION OF POLICE OFFICER (WHETHER HE/SHE IS THE DUTY SIGNATURE OF DUTY INVESTIGATOR/INVESTIGATOR ON
INVESTIGATOR, INVESTIGATOR ON CASE OR THE ASSISTING POLICE OFFICER) CASE/ASSISTING POLICE OFFICER

RANK/NAME OF DESK OFFICER: SIGNATURE OF DESK OFFICER: BLOTTER ENTRY NR:

PO2 Jerome N. Ofilas 2022-021
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
Mobile Phone
of Office