IN THE COURT OF HON’BLE ______________________

.........Complainant

Versus

...........Accused

I,_____________________________________________ (Name of the

Surety)solemnly affirm and state as follows:-

1. I beg to offer myself as surety for the

Accused/Applicant___________________________ who has been
charged under Section_________________ and who has been
ordered to be released on bail for the sum of Rs.
_____________( Rupees______________ with the one /
Surety/ Sureties in the like amount by the Order of this
Hon’ble Court dated__________________.

2. I give below the particulars concerning myself.

a. Name
Qualification
Residential Address
Rent Paid Yes/No.

b. Occupation/ Business
Business Address
Nature if Business
Sureties Share therein
Rent Paid/ Yes/No
If rent bill is in sureties name.

c. Is surety in service
Name of the Employer
Address of the Employer
Address of Place of Service
Salary Drawn.
Length of Service.

d. Full particulars of the

 house property owned
Any encumbrances
e. Amount of income tax paid
Bank Account Number
Amount in each account
f. Period for which the surety knows the Accused
Relationship with the accused.
Weather stood surety for any other accused in preceding
six months.
Name of the Party
Case Number
Whether surety bond was forfeited
Whether surety ship was rejected
Weather surety is involved in any criminal litigation
g. Any other particulars surety intends to
give__________________________________.
3. I am Producing the following document/ Proof in support of
my statement and give particulars as below.
4. I pray that, I be accepted as surety for the above named
accused in the sum of Rs____________
Rupees______________________________ vide
________________________________________________
5. I hereby declare that, I have not stood surety in any other
pending case or cases.

Solemnly Affirmed on this _____________day of month

of______________ of _______________.

_____________
Signature of Surety
Identified by
(Advocate)
__________________
Before me
Judge/ Magistrate