Scl'duieXLVII-;Form
No.118
'P.M.ForrnNo.26
. . . .I z o o
4235?5
FIRST
INFORI\.IATION
REPORT
(P.tvl.Rule143)
(Under
Section
154er. p. C )
$ Strikeoulwhicltis notappticabte
1.
'Distdct
....p.S.
( | i i )' A c t - .
...........'sections....
(iv)'OtherActs
and-sections
3. (a) StationDiaryReference:
EntryNo.
(b) *Occurrence
or Offence:
'Day. .
(c) fnformation
received
Date.
at the Potice-station
:
......
. . . ...Date
..Time
....G+*,
..Time
S. D.E. |Jo.
(d) 9ateof desparch
fromp. S.
4.
Typeol Informalion
:
5.
Placeof Occurrence
:
'Written/Oral
(a) Directionand Distancefromp. S.
(b) *Address
'..r':.
.BeatNo.
(c)lncas'eoutSide|imitofthisPolice-station,thenthenameofP.s.'.."'.
Distrid.......
.., !.s.1.
.,............:,..
(f) PassportNo......
. . . . . . D a t e olfs s u e .
. . P l a c e ot st s u e
(g) Occupation
...S.C./S.T.
7.
nl',^,'^',?.cused
Detailsof known'silspolted/unl
(attachseparatesheet,if necessary)
8.
Reasons
fordelayin reporting
by theComplainanVlnformant.
9.
(attachseparatesheet,il required).
Pailicutars
of prcpertiesstolenfinvol'/cC
3
10
'Apprclxinrale
v a l u r . ' o ll . i r o p e r l i essl o ! i ; r i i ! n v o l v e d
. . . ^-. ., .
1'l
.inc;ue'st
Iieport/LJ
[) casleNo , if any,
12
f : . . 1t l C o n l e n t s( a l t l c hs e p a r a t se h e c l r i1 1r e q u i r e d ;
''13, Actiontaken:,Since
the abovereportrevealscomrni$ionof offence(s)
u/s (asmentioned
at iiem No.2,)
registepdth"ecaseaqdrelused investigation/and
tookup the frvestigation/directed:land
..,.
h a s a l r e a d y t a k e n u p A 6 t a k e u p A h e i n v e s t i g a t i o M r a n s"{' n
e "r r- e
, ,d. .t.o. -P. .. S
^ t,..,,. o . . , . a . .
on pointof jurisdiction.
I
F. l. R. readover to the Complainanl/lntolmanl,
admittedto be correctlyrecordedand a copy givento rhe
Complainantllntor,mait
lree of cosi.
Signatureol the Officer-in-charge,
Pdtice-station
with
'Naitie.
'Rank.
PersnalNunber,if any
Date
\

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