s.

D
_, '. N.C.R.B ((a.fl.sn.ah)
- - - - - - - - - - - ---,;;:--- -:;:
.- -----;; -

1.1.F.-V (~~ QITTf -V)

(xvi)Details of bailers / sureties(-ii1H-1fi?t4">j q;r iwfm):
Name (IT):
Father's/Husband's Name (firnT/Q"Rt- cfiT ;mr) :
Occupation (araarz1):
Address (uaT):
s.No.(s.&.)dress
Tye(ran
ar
j rNa@
Identification (Ta): Date of Birth (a-ff2).
an
UID Number (qsn{st i.):
Any Other ID Proof(~~ tEf):
S.No.(q.i.) /ID Type (u<arr ur ar var) /ID Number (uzar ua .)
I revous convictions
(xvii)Pr ct i wIith case re ±feerences (mm? hizf
~ «fa,uga g{ +mi 'q;'f 'fa):e ¢1
'
,mo4 v.v>j
S.No. FIR No. State District Police Description Of Details Of Conviction /
Station Case Acquittal
(ffi.-«.) (7.4.f. (rear) (fan) (z11+) (irr? ar Rau) (rs / 3mrluiqn nr frawr)
ho

(xviii)Status of the accused ( ~ffi c#rr ~): FORWARDED TO COURT

12. Particulars of accused persons - not charge sheeted(suspect) ( 3ITT1'Q' ~~-'I' fif;-q- TTQ"(-«~)~tffi

13 .Particulars of witnesses to be examine_~'!,0d IE§ ~ m~

S.No. Name Father's/Husban Date/Year of Occupati Address Type of evidence
d's name birth on to be tendered
(lii. .t.) (am) (fira-rftmf lliT 'fllr) (anaff2ntafj (araara) (ua) (JaWf f.l;q- ;;rr,l ~
T41 al Va6T)
Present Address:
SI of Police,
Sadar PS,
Smruti SADAR,
Ranjan NAYAGARH,
1 Father: Bhagirathi ODISHA,INDIA
Mohant 1991 Complainant
Mohanty Permanent
y-Age-
30 Yrs. Address:
Anianka,
BALIKUDA,
JAGATSINGHPU
R,ODISHA,INDIA
Present Address:
ASI of Police,
Ashok Sadar PS, NGR,
Father: SADAR,
Kumar SERVIC
2 Nityananda 1963 NAYAGARH, Eye Witness
Mohant E
Mohanty ODISHA,INDIA
y
Permanent
Address:
Parichhal,

3
 6
N.C.R.B ((a.ft.snr.an

- ·---
I.I.F.-V (VB6otaa sfa uf -v)
BEGUNIA,
KHURDA,
ODISHA INDIA
Present Address:
- Havildar of Sadar
PS,SADAR,
NAYAGARH,
Kailash ODISHA,INDIA
Father: Late- SERVIC
3 Chandr 1962 Permanent Eye Witness
Agadhu Rana E
a Rana Address:
Lekhanpur,
RANPUR,
NAYAGARH,
ODISHA,INDIA
Present Address:
Malisahi,SADAR,
NAYAGARH,
Saroj ODISHA,INDIA
Search & Seize
4 Kumar Father: Magi Jena 1982 Permanent
Witness
Jena Address:
Malisahi,SADAR,
NAYAGARH,
ODISHA,INDIA
Present Address:
Malisahi,SADAR,
NAYAGARH,
Prafulla ODISHA,INDIA
Father: Late- Search & Seize
5 Kumar 1969 Permanent
Basudeb Pradhan Witness
Pradhan Address:
Malisahi,SADAR,
NAYAGARH,
ODISHA,INDIA
Present Address:
SIRISIRA,
BANIGOCHHA,
NAYAGARH,
RAJEN
ODISHA,INDIA
ORA
6 13/08/1973 Permanent 10
KANHA
Address:
R
SIRISIRA,
BANIGOCHHA,
NAYAGARH,
ODISHA,INDIA