FORM – IF3 - (Integrated Form)

ARREST / COURT SURRENDER MEMO

(Separate Memo for each accused)

1. *Dist. SONIPAT *P.S. RAI POLICE STATION *Year 2023 *FIR No. / Proceeding No.
2023000XXX *Date 3RD NOVEMBER 2023
2. Alphanumeric code of the Accused A1
3. Date & Time of Arrest / Surrender: 3RD NOVEMBER 2023
4. Time:10.47 P.M.
5. Name of the Court (if surrendered): SONIPAT SESSIONS COURT
6. *Acts and Sections: ARMS ACT, 1959, SECTION 304, SECTION 299
7. ARRESTED AND SENT UP
8. Particulars of the Accused:

(i). *Name: VICKY PANDEY

(ii). *Father’s / Husband’s Name: NOT KNOWN

(iii). *First Alias: NOT KNOWN

(iv). *Second Aliases: NOT KNOWN

(v). *Other Aliases: NOT KNOWN

(vi). *Nationality: INDIAN (vii) (a) *Passport No. NOT FOUND

(b). *Date of Issue: NOT FOUND (c).* Place of Issue NOT FOUND

(viii). *Religion HINDU (ix). *Caste / Tribe BRAHMIN

(x). *SC/ST: YES (xi) *Occupation: CLERK

(xii). *Permanent address: 241 HIND RAJASTHAN NAGAR, DAINIK BHASKAR ROAD,
RATHDANA Distt. SONIPAT P.S. RAI POLICE STATION

(xiii) *Present Address: 241 HIND RAJASTHAN NAGAR, DAINIK BHASKAR ROAD,
RATHDANA Distt. SONIPAT P.S. RAI POLICE STATION

9. Injuries, cause of injuries and physical condition of the accused person (Indicate if medically
examined):
They saw that the eyes and mouth of the deceased were partly open. The blood was oozing from the dead’s
nose and mouth. It was also noticed that there was a deep cut on the other side of the face (the side lying
on the ground), possibly caused by the fall on the tree. They saw a fresh wound near the chest area of the
deceased. This fresh wound was a round hole that could be seen at about 7 cm. to the left of the right
chest nipple. The bullet wound is at about 12cm to the right, from the left chest nipple and 10 cm from the
neck. Further, on the shirt of the deceased, a hole of 1.5 X 1 cm. to the right of the 2nd button was found,
and there were also bruises on the face and neck. Slight abrasions were also seen on the face, which
could be viewed without moving the body. They could not find any other injury besides these on any other
body part. Further, the medical report of Deepak’s body indicated that the death had taken place due to
the bullet injury and the report was submitted to the police at 9:00 a.m. on 8th November 2023
10. The accused, after being informed of the grounds of arrest and his legal rights, was duly taken into
custody on 3RD NOVEMBER (date) at 10.47 P.M. (hours) at 241 HIND RAJASTHAN
NAGAR, DAINIK BHASKAR ROAD, RATHDANA, SONIPAT
(place). The following article(s) was / were found on physical search, conducted on the person of
the accused, and were taken into possession for which a receipt was given to the accused. **

1 N.P. Pistol PBERETTA – CAL – 9 CORT – MC 1934 BREVETTATO GARDONE V.T. 193
2 BLACK WALLET
3 COLLEGE ID CARD AND VISITING CARDS OF DEEPAK
4 GUN SILENCER
5 500-RUPEE NOTES AMOUNTING TO RS. 50000

Necessary wearing apparels were left on the accused for the sake of human dignity and body
protection. The accused was cautioned to keep himself / herself covered for purpose of
identification.
** If no article found, ‘Nil’ may be indicated in the blank space provided below:

11. Physical features, deformities, and other details of the accused:

*Sex *Date / Year of *Build *Height in *Complexion *Identification

Birth Cms. Marks
1 2 3 4 5 6
MALE 1996 STRONG 173.74 cm LONG JET- NIL
BLACK HAIR

(For Modus Operandi offences only)

*Deformities *Tech *Hair *Eye *Habit(s) *Dress habits

/ peculiarities
7 8 9 10 11 12
NIL NIL NIL NIL NIL ORANGE SHIRT
AND BLACK
PANT
*Languages PLACE OF
/ Dialect *Burn Mark *Leucoderma *Mole *Scar *Tattoo
13 14 15 16 17 18
NIL NIL NIL NIL NIL
PUNJABI
*Other features (19) NIL

12. Whether finger-print taken or not?: YES

13. Socio-economic profile of the accused showing:

(a). *Living Status: LIVING ALONE

(b). *Educational qualification(s): NOT KNOWN

(c). *Occupation: CLERK

(d). *Income Group: NIL

14. Whether the accused person, as per the observations and known Police records:

*(a) Is dangerous NO
*(b) Previously escaped any bail NO
*(c) Is generally armed NO
• Operates with accomplices NO
• Has past criminal records NO
• Is recidivist NO
(g) Is likely to escape bail NO
(h) If released on bail, is likely to commit another crime NO
(i) Immediately or threaten the victims / witnesses. YES
(j).Is wanted in any other case NO
Signature of the Investigating officer with:

Name: MR. HOLMES

Rank: INVESTIGATION OFFICOR,
INSPECTORE
Number, if any: 91+ 945XXXXXXX
Date: 3RD NOVEMBER 2023
Place RAI POLICE STATION