Investigation Data Form
Investigation Data Form
s 2008
COMPLAINANT/S: Name, Sex, Age & Address RESPONDENT/S: Name, Sex, Age & Address
Pinnacle Supply Chain, Inc. _______________ Florinda B. Guevarra, Female, __ years old____
represented by Slyvia M. Refuerzo__________ address: Faith Canteen & General Merchandise
Female, __years old________________________ 1860 Augusto Francisco St., San Andres Bukid__
Address: Unit 401 Metropolitan Tower_______ Sta. Ana, Manila; AND______________________
1746 A. Mabini St., Malate, Manila_____________ Abby Jean Baltazar, Female, __ years old______
Address: 28 Inocencia St., Tugatog, Malabon City
1. Has a similar complaint been filed before any other office? YES ______ NO ________
2. Is this complaint in the nature of a counter-affidavit? YES _______ NO _________
3. Is this complaint related to another case before this office? YES ______ NO ________
If yes, indicate details below:
CERTIFICATION
I CERTIFY, under oath, that all the information on this sheet are true and correct to the best of my
knowledge and belief, that I have not commended any action or filed any claim involving the same issues in any
court, tribunal, or quasi-judicial agency, and that if I should thereafter learn that a similar action has been filed
and/or is pending, I shall report that fact to this Honorable Office within five (5) days from knowledge thereof.
SLYVIA M. REFUERZO
(Signature over printed name)
SUBSCRIBED AND SWORN TO before me this _____________ day of ______________, in City of Manila
________________________________
Prosecutor Administering Oath