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nTi.me Perioci ,..........*Timc From..........1...... "'lirrre'l'nffi3;sr\; -* Zr: loD qTTtW"

*Cti-ier Acts & Scctions ...-5r lilrF-ltm r.FTl:;

'oC)ccrirencc of O ii-cnce :

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Intbrrnation reccivcd at P S.Date ..

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Ccnclal Diary Rr:i'erencc Srlln'Notr,iwrrrq ffit;i qfEr{ n;qta

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Naine of P.S. .................,*dle'-ddf

Complainant f Informant :

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(f) Occu pation :

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Detaiis usoectecl / urtkltoq,n accused litithql,ta crEdi-qri {pl{lfl/ qrfta

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(Attach separatc sheet, if necessaryJ(efiEri'6 of{rcqTr+, 611i7 6pr< 'rt-srqr)

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*Complexion

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*ldentification Mark(sJ

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Physicai features, defcrrnities and othel details of the suspect :

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* Languages/Dialect

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PLACE OF

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*Leucoderma

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(13) .(14) (1s) (16) (17) (18)

These fields will be enterecl onl;' if complainant/informant gives an-v one or more partictrlars about thesuspect. This u'ill bc used onl-r' for the purpose of prelirninary retrir:val to assist I. O.

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9. Particulars of properties stolen/ir-rvolved {Attach separaie shegt, if necessar--rr)'qi-ft-s'id-cqrl 3lf,fd ql-ffiiET nqqft.{ (emr+6 3t{isTT{t, rqera miir< .a}'srsT) ,

Reasqns'({qrT!<llti/

No.

11.

10.

12.

14.

*'lotal value of properties stolen/involved*ftT.)-+@Tiero+fr q6q3.l yfrT Xe :

*lnqnest Report/ U. D. Case No., if an1.' : ..

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F. I. R. read over to the Complainant/lnformant /admitted to be correctll. r""ord"O and a copygiven to the Complainant/lnforinant free of cost.qftnft sq-{ nmrsffrdT/q{ft-dr qTfi flsffi, e+fi l}{{S q$E{rn qqd rTFq i;a snFr .rrFlrqrr(.{T/e-{edT qd 4q-cr i?d.

Signature /Thumb impressionof the Complainant/ Informant.ildrilir*/sqt-fr s$7eir-dqqrffi l

Signature of t be-in-c-6ar:ge, Poiice Station

Date & Time of despatch to the court : .............defu qrdM .nq1-e q i-o

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