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Investigation Data Form
Electrical Engineering (EE110)
Adamson University
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1
Integrated Bar of the Philippines COMMISSION ON BAR DISCIPLINE Pasig City
INVESTIGATION DATA FORM
To be accomplished by the CBD (first part)
DATE RECEIVED: _____________________ U. No. ______________________ TIME RECEIVED: ______________________ (Under Evaluation) Receiving Staff: ________________________________________________________________ (complete name and signature over printed name)
To be accomplished by Complainant/s/Counsel (second part)
COMPLAINANT/S: COUNSEL: NAME: ________________________________ NAME: _____________________________ ADDRESS, EMAIL: ______________________ ADDRESS, EMAIL: __________________ CONTACT NO: _________________________ CONTACT NO: ______________________
ETHICAL VIOLATIONS: WITNESS/ES, if applicable
______________________________________ NAME: ______________________________________ ADDRESS: _________________________ CONTACT NO.: _____________________
RESPONDENT/S:
NAME: __________________________________________________________________ ADDRESS, EMAIL: ____________________________________________________________ PRIVATE PRACTITIONER? _____________________________________________________ GOVERNMENT EMPLOYEE? ___________________________________________________ (IF YES, INDICATE AGENCY AND ADDRESS)
Have you filed a similar complaint (administrative, criminal, or civil) against the respondent lawyer/s before any other office, agency, court or tribunal, judicial or quasi-judicial?
If yes, please state the case title, name of office, agency, court or tribunal, judicial or quasi-judicial, and the status of the case.
2
Is this administrative complaint in the nature of a counter- charge?
Is this administrative complaint related to another case/s filed/pending before this Office? ____________. If yes, please state title of the administrative case.
CERTIFICATION
I HEREBY CERTIFY, under oath, that all the information in this document are true and correct to the best of my own knowledge and belief, that (if applicable, except for [state case title, number, pending before any office, agency, court or tribunal ), I have not commenced any action or filed any claim involving the same issues in any office/agency/court/tribunal, judicial or quasi-judicial, 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.
__________________________________
(Signature over printed name)
SUBSCRIBED AND SWORN TO before this ________ day of _____, 20.
________________________________________________
Notary Public/Administering Officer
Investigation Data Form
Course: Electrical Engineering (EE110)
University: Adamson University
