Share

DOJ-BOC Form No. 1 Board of Claims

DOJ application form for the grant of compensation for victims of unjust imprisonment or detention and victims of violent crimes.

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Revised DOJ-BOC Form No. 1

BOARD OF CLAIMS
(R. A. No. 7309)

Department of Justice
Manila

Picture

APPLICATION
1.

Name of Applicant

:

__________________________________________

2.

Address (Residence) :
Telephone
:

__________________________________________
__________________________________________

3.

Business Address
Telephone
:

:

__________________________________________
__________________________________________

4.

Date & Place of Birth :

__________________________________________

5.

Civil Status

6.

Name of Spouse

7.

Name of Child / Children:

:__________________ Nationality : ________________________
:

__________________________________________

Name
Date & Place of Birth
Age
a.______________________________________________________________________
b.______________________________________________________________________
c.______________________________________________________________________
d.______________________________________________________________________
e.______________________________________________________________________
8.

Nature of Claim:

(Check appropriate box and attach documents indicated)

a.

Unjustly accused, convicted and imprisoned but subsequently released by
virtue o judgment of acquittal.

( )
( )
( )

Certified True Copy of lowers court’s decision of conviction;
Certified True Copy of appellate court’s decision of acquittal; and
Certified True Copy of commitment order and released from
confinement by the jail warden or prison authority concerned.

b.

Unjustly detained and released without being charged.

( )

Any proof to show that he was unjustly detained without being charged.
(e. g. such as records of arrest; detention and release.)

c.

A victim of arbitrary or illegal detention by the authorities and defined in
the Revised Penal Code under final judgment of the court.

(2)
d.

Victims of Violent Crime:

( )

Certified True Copy of Police Report
(Spot and Casualty Report in case of KIA);
Certified True Copy of Autopsy Report in case of Death;
Certified True Copy of Doctor’s Medical Certificate
(for Serious Physical Injuries/Rape);
Certified True Copy of Psychiatrist Certificate; if applicable; and
Certified True Copy of Death Certificate and
Medical Receipts, etc. (in case of Serious Physical Injuries)
Certified True Copy of Resolution / Information (in case of Rape)
For KIA, Certificate of Legal Beneficiaries / Declaration of Legal
Beneficiaries (Authenticated Copy)
For WIA, Certificate (wounded) with journal (Authenticated Copy)

( )
( )
(
(
(
(
(

)
)
)
)
)

( )
9.

If claimant is an heir, he/she shall submit the following :
(
(
(
(

)
)
)
)

Certified True Copy of Marriage Certificate if claimant is the spouse;
Certified True Copy of Birth Certificate if claimant is a child/parent; or
Proof of relationship that the claimant is the mother/sister/grandparent.
Baranggay Certificate

Brief narration of incident giving cause of claim :
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
________
10.

History of Claim :
a. I.S. Crim. Case No. :_________________________________________
b. Compainant
:_________________________________________
c. Respondent/Accused:________________________________________
d. Nature of Offense :_________________________________________
Right thumb
mark
________________________
APPLICANT
(Signature over printed name)

SUBSCRIBED AND SWORN to before me this _____ day of_______________
2008, in the City of Manila, Philippines.

ADMINISTERING OFFICER

kayebongjanuary2008
 
Page of
Share