FORM IF5

FINAL FORM / REPORT

(Under Section 173 CR. P.C.)

IN THE COURT OF HMJ SATISH JHA ACMJ ROHTAK

1. *Dist: Rohtak *P.S: Sampla *Year: 2023 *FIR No: 6354 *Date: 15/10/2023

2. Final Report/Charge-Sheet No: 01 3. *Date: 20/10/2023

4. (i) *Act: Indian Penal Code, 1860 *Section: 354, 509

(ii) *Act: POCSO Act *Section: 12
(iii)*Act: …..………………………………… *Section: …………………………………………
(iv) *Other Acts and Sections: ………………….…………………………………………………….

5. *Type of final Report: Charge-Sheet

6. *If F.R. unoccurred: False / Mistake of fact / Mistake of law/Non-cognizable/Civil nature:……….

………………………………………………………………………………………………………..

7. *If supplementary or original: Original

8. Name of the I.O. Basant Rana Rank SI (Sub-inspector)
(a) Name of Complainant / Informant: Ragina Khatoon
(b). Father’s / Husband’s Name: Mohd. Abid

10. Date of properties / Articles / Documents recovered / seized during investigation and relied upon
(separate list can be attached, if necessary).

Sl. Property Estimated value P.S. property From whom/where Disposal

No description (in Rs.) Register No. recovered or
seized
1 2 3 4 5 6
11. Particulars of accused persons charge-sheeted:
(use separate sheet for each accused)

Sl.No. 1
(i). *Name: Mohd. Abid Whether verified: Verified
(ii) Father’s/Husband’s Name: Mohd. Siraj
(iii). Date/Year of Birth: …
02/02/1987………………………………………………………………………
(iv). Sex: Male…………………………………(v) Nationality ……
Indian………………………………….
(vi). Passport No: …31195855……………………… Date of issue …………Dec
18,2014……………………………..
Place of Issue …
Mumbai,India……………………………………………………………………………..
(vii). Religion: …Muslim…………………………. (viii) Whether SC/ST ……………………………….
(ix). Occupation: …………………………………………………………………………………..
(x). Address: 121, Jamai Nagar, Rohtak, Haryana Whether verified: Verified
(xi). * Provisional Criminal No.: 07
(xii). *Regular Criminal no: ……………………………………………………………………….
(if known)
(xiii). Date of arrest: ……………………………………………………………………………….
(xiv). *Date of release on bail ……………………………………………………………………..
(xv). *Date on which forwarded to Court: ……………………………………………………….
(xvi). *Under Acts & Sections: u/s 354, 509 of IPC and 12 of POCSO ACT
(xvii). *Name(s) and Address(es) of sureties: ……Md. Faizan 4th Floor, Haryana Civil Secretariat, Sector-1,
Chandigarh. Pin code: 160001…………………………………………………
………………………………………………………………………………………………..
………………………………………………………………………………………………..
(xviii). Previous convictions with case references: ………………………………………………….
………………………………………………………………………………………………..
……………………………………………………………………………………………….
(xix). *Status of the accused:

In judicial Custody
12. Particulars of accused persons – Not charge sheeted (suspected):
(separate sheet for each suspect)

Sl. No…..

(i). *Name: …………Mohd Sultan………………………….. Whether

verified…………………………...
(ii). Father’s/Husband’s Name: ………Mohd
Iqbal…………………………………………………………..
(iii). Date/Year of Birth : ……23/07/1988………………….
…………………………………………………
(iv). Sex: …………Male………………… (v) Nationality: …
Indian………………………………………..
(vi). Passport No. …………431276122………………….…. Date of Issue
…………………………….......
Place of Issue ………………………………………………………………………………...
(vii). Religion: ……Muslim…………………………… whether SC/ST: ………………………………...
(ix). Occupation: …… Shopkeeper
……………………………………………………………………………..
(x). Address: 119, Jamai Nagar, Rohtak …………………………………………………. Whether
verified: ………………
(xi). *Provisional Criminal No: …………………………………………………………………...
(xii). *Suspicion approved: Yes/ No
(xiii). *Status of the accused
Bailed by Police / Bailed by Court / in judicial custody / Absconding / proclaimed offender
/ Not arrested: ………………………………………………………………………………...
………………………………………………………………………………………………..

(xiv). Under Acts and Sections: ……Section 354, 509 of IPC Section 12 of POSCO
Act……………………………………………………………….
………………………………………………………………………………………………..

(xv). Any special remarks including reasons for not charge sheeting: …………………………….
………………………………………………………………………………………………..
………………………………………………………………………………………………..
………………………………………………………………………………………………..
………………………………………………………………………………………………..
………………………………………………………………………………………………..
13. Particulars of witnesses to be examined:

Type of
Father’s/Husband’s Date/year of
Sl. No. Name Occupation Address evidence to
Name birth
be tendered.
1 2 3 4 5 6 7

1. Rukhsar Mohd. Abid 12/06/2013 - 121, Jamai Victim

Nagar,
Rohatk

2. Mohd. Sultan Mohd. Iqbal 23/07/1988 Shopkeeper 119, Jamai Neighbour

Nagar,
Rohtak

3. Rohit Kumar Sajjan Kumar 30/12/1974 Insurance 123, Jamai Neighbour

Agent Nagar,
Rohtak

14. If F.R. is false, indicate action taken or proposed to be taken u/s 182/211 I.P.C.:

……………………………………………………………………………………………………..

15. Result of Laboratory Analysis:

NONE
16. Brief facts of the case (Add separate sheet, if necessary)
- Ragina Khatoon lives with her four children and does household works. Her husband, Moh. abid
works as a carpenter. Her husband spends whatever he earns on alcohol. About 4 years ago,
Mohammad Abid tried to do assault Rukhsar. His wife protested against him due to which he stopped
and apologized but after that also he regularly used to assault and sexually harass Rukhsar.
- One day Rukhsar was changing her clothes and Mohd. Abid opened the door and looked at her with
the wrong intention to assault her.
- Recently, Mohd. Abid was drunk and sexually assaulted Rukhsar for hours. He also pushed and
slapped Sajid, his son several times.
- Ragina Khatoon filed a complaint about all this and subsequent to that police lodged a FIR on 15th
October 2023.
- After investigation, police came to know from Mohd. Abid’s neighbour beat his children and wife
after drinking on a regular basis.
- Later, police arrested Mohd. Abid from his residence.

17. Refer Notice served: No Date: 20/10/2023

18. Despatched on 20/10/2023

Forwarded by Station House Officer Signature of the Investigating officer

submitting the Final Report / Charge Sheet

Name: Ramvir Singh Name: Basant Rana

Rank: SHO No: 99F4 Rank: Sub-inspector No: 98G5