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(Under Section 154 Cr.P.C)

1.     District ___________ Police Station________ Year ________FIR No._____ Date_____

2.     Act___________ Sections______________


a.     Occurrence of offence: Date ________Time Period_____________

b.    Information received at Police Station Date_________ Time_________

c.     General Diary Reference: Entry No_________ Time____________

4.     Type of Information Written/Oral

5.     Place of Occurrence:

a.     Direction and distance from P.S__________ Beat No________

b.    Address________________

c.     In case,, outside the limit of this P.S., then Name of Police Station_____________________ District_______________________

6.     Complainant/Informant:

a.     Name_________________

b.    Father's/Husband's Name_________________

c.     Date/Year of Birth ___________

d.    Nationality

e.     Address_________________________

7.     Details of known/suspected/unknown accused with full particulars.

              i.        ____________________________________

             ii.        ____________________________________

8.     Reasons for delay in reporting by the complainant/informant

9.     Particulars of properties stolen____________________

10.  Total value of property stolen____________________

11.  Inquest Report/U.D case NO., if any__________________

12.  FIR Contents:_____________________

13.  Action Taken: Since the above information reveals commission of offence(s) u/s as mentioned at Item No.2:

1.     Registered the case and took up the investigation or

2.     Directed/Entrusted (Name of I.O)__________ Rank_________ No___________ to take up the Investigation or

3.     Refused investigation due to _____________ Or

4.     Transferred to P.S____________ District___________ on point of jurisdiction.

FIR read over to the complainant/informant, admitted to be correctly recorded and a copy given to the complainant/informant, free of cost.

Signature of Officer in charge, Police Station


Rank_________ No________

14.  Signature/Thumb impression of the complainant/informant.

15.  Date and time of dispatch to the court ___________________

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