FIR Form (Draft)

(A sample FIR form is provided below.)


(Under Section 154 Cr.P.C.)

District : Prayagraj    P.S. Civil lines      Year 2020

   FIR No. 0134    Date & Time of FIR : 08/01/2020, 20.51 ‘O’ Clock

      S.No.Acts Sections
         1IPC 1860     420

3. (a) Occurrence of offence :

1. Day   :  Night                                       Date From :   01/01/2020

    Date To : 08/01/2020

 Time Period   :    Time From : 08:00 ‘O’Clock 

 Time To : 12:00 ‘O’ Clock 

(b) Information received at P.S. :

          Date     :  08/01/2020                       Time : 20:51 ‘o’ Clock 

    (c) General Diary Reference  :

     Entry No. : 031                            Date & Time : 08/01/2020  20:51‘O’ Clock 

4. Type of Information  :  Written

5. Place of Occurrence  :

1.(a)Direction and distance from P.S. :  East, 4 K.M

          Beat No.  :

      (b) Address  : District-_________, U.P.

      (c) ln case, outside the limit of this Police Station, then :

           Name of  P.S. :                            District(State) :

6. Complainant / lnformant  :

(a) Name  :  __________

(b) Father’s Name : __________

(c) Date/Year  of  Birth:                     (d) Nationality : Indian

(e) UID No. : 

(f) Passport No. :                

        Date of Issue. :         

        Place of  Issue :

(h) Address :

S. No.   Address TypeAddress
   1  Present Address———

   (i) Phone number :   __________                            Mobile :+xxxxxxxxxx

7. Details of known/suspected/unknown accused with full particular:

    Accused More Than:  

S.NoNameAliasRelative’s Name             Address 
  1__________ Father name: ____________________

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

9. Particulars  of  properties  of  interest  :

S. No.  Property CategoryDescription    Value (In Rs/-)   

10. Total value of property stolen (ln Rs/-)-:

11.  Inquest Report / U.D. case No. lf any :

S. No.   UIDB Number

 12. First information contents :

                To the honorable Prime Minister Govt. of India, South blocks New Delhi. Sub :- Complaint against __________ S/O __________, R/o __________, sir, It is most respectfully submitted that after any respected complaint to S.S.P. (Place) and S.H.O. (Place), I have not yet got any fruitful result from any corner. As a result of which I have lost mental peace because the above mentioned persons property dealers have grabbed approx. Rs. 1200000.00 (twelve lakh) against a plot and no ownership has been given to me. I am enclosing herewith the relevant complaint/documents to U.P. Police which is self-explanatory. Now I appeal your good self to ask the U.P. Police to take a strong action against the aforesaid property dealers to refund the money with interest to me without any delay. Date-8/1/2020, ends:- as stated yours faithfully sd. __________ S/o __________ R/o House no- __________.

नोट – मैं C/C 2100 __________ प्रमाणित करता हूं कि, तहरीर अंग्रेजी की नकल चिक हाजा पर शब्द ‘व‘ शब्द अंकित की गयी है।                                  

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 (Name of  I.O.)           :       CO

     Rank : Dy. SP (Deputy)      No. : xxxxxxxxx

     to take up the Investigation             

(3) Refused investigation due to  :


 (4) Transferred to P.S.                    District

       on point of jurisdiction

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


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

15. Date and time of dispatch to the court:                                                                    


Signature of Officer in charge, Police Station

                                                    Name: PS Civil Lines

                                                     Rank: I (Inspector)

                                                             Mo. No. :    xxxxxxxxxx