Format of police complaint about lodging an FIR
To,
Officer in-charge
Muffassil Police Station
Patna, Bihar
Date: 2nd November, 2020
Subject: Loss of the original passport, PAN Card and Passbook
Respected Sir,
I am Manish kumar singh , d/o Shri Dudheshwar Singh, currently residing at Dangi Nagar,
Delha, Gaya. On 2nd November, 2020, I lost my original passport, PAN Card and Passbook at
the railway station at Patna at near 4:30 pm. The passport number is: xxxxxxxxx, the PAN
Card number is: xxxxxxxxxxx and the Passbook number is: xxxxxxxxxxx.
I humbly request you to kindly register the complaint and give me an attested copy of this
complaint so that I can submit this to the bank and the airport authority.
I shall be obliged if you kindly take action to trace and recover the lost device.
Yours faithfully,
Manish kumar singh
Manish kumar singh
Patna
Contact no: 9771037700
MODEL FORMOF FIRST INFORMATION REPORT
(Section 154, [Link])
Serial No.: 00
Book No: 00
1. District: Gaya; P.S: Delha; Year: 2020; FIR No.: 000 Date.: 2nd November, 2020
2. (i) Act: abcdabcdabcdabcdabcd Section: xyz
(ii) Act: abcdabcdabcdabcdabcd Section: xyz
(iii) Act: abcdabcdabcdabcdabcd Section: xyz
(iv) Other Acts & Sections: XYZXYZXYZXYZXYZXYZXYZXYZXYZXYZ
3. (a) Occurrence of offence Date from: 02/11/2020 Date to:
02/11/2020
Time Period: xyz Time from: 4:30 pm Time to: 5:00 pm
(b) Information received at P.S.: Muffassil Police Station, Patna
Date: 02/11/2020 Time: 5:30 pm
(c) General Diary Reference: Entry No: xyz Time: 5:35 pm
4. Type of Information: Written
5. Place of occurrence
(a) Direction and distance from PS: 2 kms Beat No: XYZXYZXYZXYZXYZXYZ
(b) Address: Railway Station, Patna
(c) In case outside the limit of Police Station, then
Name of P.S: N/A District: N/A
6. Complainant/Informant
(a) Name: manish kumar Singh
(b) Father's Name: Shri Dudheshwar Singh
(c) Date/Year of Birth: XX/XX/XXXX
(d) Nationality: Indian
(e) Passport No: xxxxxxxx Date of Issue: xx/xx/xxxx Place of Issue: xx/xx/xxxx
(f) Occupation: Student
(g) Address: Dangi Nagar, Delha,
Gaya,Bihar..................................................................................................................
....................................................................................................................................
...........................................
(h) [Link]: 0123456789
7. Details of known/suspected/unknown accused with full particulars(Attach separate
sheet, if necessary)
(1) ………………………………………………………………………………………
………………………………………………
(2) ………………………………………………………………………………………
………………………………………………
8. Reasons for delay in reporting by the complainant/informant: N/A
9. Particulars of properties stolen (Attach separate sheet, if necessary: )
………………………………………………………......................................................
..........................................................................................................................................
................................
10. Total value of property
stolen……………………………………………………………………………………
……………
Serial No.: 00 Book No: 00
11. Inquest Report/U.D. case No., if
any...........................................................................................
12. F.I.R. Contents (Attach separate sheet, if required)
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
…
13. Action taken: Since the above report reveals commission of offence{s) u/s XYZ as
mentioned at Item No. 2
(1) Registered the case and took up the investigation or
(2) Directed/Entrused (Name ofIO.): Mr. LALALA Rank: Officer in-charge No: 000
PIS No: 000 to take up the investigation or
(3) Refused investigation due
to……………………………………………………………………………………
……
(4) Transferred to PS..............................................District..........................on point of
jurisdiction. F.I.R. 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 /Duty Officer, Police Station
R.O.A.C. Name: Mr. LALALA
Rank: Officer in-charge NO: 000
PIS No. _ _ _ _ _ _ _ _
14. Signature/Thumb-impression of the
complainant/informant………………………………………….……..
15. Date and time of despatch to the
Court....................................................................................................
