GUYANA POLICE FORCE

Form A: 30
POLICE ACT - DISIPLINARY SHEET

Number.............................................Rank......................................Name........................................

Offence Plea Finding Punishment

Murder Kidnapping Thieving

Date Charged:
Copy of charges handed to Defaulter at A.M

P.M 20 By:
Date Disciplinary Inquiry began

Adjourned :-

Date punishment awarded :-

Signature of Commissioner :-
Date Decision on review communicated to defaulter:-
Signature of officer :-
Date Police service Commissioner of Appeal Communicated to Defaulter:-
Signature of Officer:-
SUMMARY OF EVIDENCE AND REASONS FOR RECOMMENATION

I hereby certify that a copy of this charge sheet was served

on......................................................................................................................................................
at............................................................................on......................................................................
.

.....................................................

I have been told that I have a Defaulter's Friend and that I must indicate that the name and
address of witness as I may wish to call on my behalf.

......................................................

I................................................................................do hereby request that this disciplinary

matter commence immediately as provided for under Section 5(ii) of the Police (Discipline)
Act Chapter 17:01

Date..........................................Time...........................................Signature......................................