To
District Probation Officer/Court.
Copy to Chief Probation Officer.
Probation Officer
Date of Report.
Address :
Form III
[See Rule 14(1)]
Report On Preliminary Enquiries
(Under the Probation of Offenders Act, 1958)
Serial No. _____________
In the Court of the ___________________ Magistrate, __________________ (Place) _____________________ (District) _____________________________ C.C. No _______ 19 ____________ Date of hearing ____________________
[Offence :-] [Give section and brief description.] ______________________
State __________ (Police Station) ___________ Crime No _________ 19 _____
[Name of Offender] [ In block letters.] ________________________________________
Address (Place of Residence) _______________________________________
Age __________________
Sex and religion ________________
Personal History
Behaviour and habits (moral, recreational etc.) _______________________________
Temperament (outstanding character and personality traits) _____________________
Physical and mental history and present condition _____________________________
Leisure time activities __________________________________________________
External Influences
School record and report of teachers, if available ______________________________
Employment history _____________________________________________________
Present occupation and wages (give also conditions of labour' leisure. etc.) _______________________________________________________________________________
Report of employer, if any _________________________________________________
Associates___________________
Contact with social and religious organisation, if any ____________________________
Home conditions ________________________________________________________
Father ___________________________________________________________
Mother ___________________________________________________________
Step-father ________________________________________________________
Step-mother _______________________________________________________
Brothers __________________________________________________________
Sisters ____________________________________________________________
Wife _____________________________________________________________
Children ___________________________________________________________
Other interested relations, if any _________________________________________
Economic condition of the family.
Any social agencies, institutions or individual interested in the family __________________
Report of parents and relations _______________________________________________
Attitude of family towards offender and extent of its influence on her ___________________
Report of neighbours _______________________________________________________
Home surroundings and general outlook.
Is poverty or unsettled life the cause of offence ? _________________________________
Legal History
Previous institutional record, it any ____________________________________________
Statement of the present offence and circumstance in which it was committed _________________________
Offender's own [reaction] [Substituted by GSR 6/CA-20-58.S-18-Amd. (1)-64, dated the 20th December, 1963.] to the offence and his attitude towards possible punishments ____________________
Any special information required by Court -
Factual background of offender and his environment and offence.
Diagnosis (offender's attitudes defects in character of family, motivations and other factors regarded as casual factors for the offence).
Prognosis (Treatment considered most suitable and estimates of chances of improvement).
Recommendation (if asked for by Court) _____________________
Name and address of the Probation Officer _______________________
Station ________________________
Date _____________________________
Nature of disposal of the case ______________________Probation Officer
Date of disposal _____________________________
Form IV
[See Rule 24(1)]
Order under sub-section (2) of section 4 of the Probation of Offenders Act, 1958
Probation Officer __________________________________________________
Whereas a report under sub-section (2) of Section 4 of the Probation of Offenders Act, 1958 (Central Act 20 of 1958), or under the provisions of ________________ is required for dealing with
name _________________________________________________________
son of/daughter of ______________________________________________
of (full address) _________________________________________________
who has been brought before the Court under section ____________________ in case No. __________________________________
you are hereby directed to collect or arrange to collect the necessary information after making an enquiry and place the same before this Court on ______________.
Signature of the Presiding Officerof the Court
Seal of the Court.
Form V
[See Rule 25]
Bond to keep the peace and to be of good behaviour under sub-section (1) of section 4 of the Probation of Offenders Act, 1958
In the Court of the ________________________ Magistrate.
Case No _________________ of 19____
Whereas I,___________________inhabitant of __________ have been ordered to be released by the Court of ___________ on condition of my entering into a bond to appear and receive sentence when called upon during a period of _____________.
I hereby bind myself -
(1)
to appear and receive sentence when called upon to do so;
(2)
not to commit a breach of the peace or to do any act that may occasion a breach of the peace; and
(3)
to be of good behaviour to the Government and all the citizens of India _________________________ during the said period. In case of my making default therein, I hereby bind myself to forfeit to Government the sum of Rupees ______________
Dated this _____________ day of __________ 19_______ Executed before me.
(Signature) ______________
(1)
to appear and receive sentence when called upon to do so;
(2)
not to commit a breach of the peace or do any act that may occasion a breach of the peace; and
(3)
be of good behaviour to Government and all the citizens of India ________________ during the said period.
In case of his making default therein I/we bind myself/ourselves jointly and severally, to forfeit to the Government a sum of Rupees _______________
Dated this _____________ day of ___________________ 19____
(Signature) _______________
(1)
that he will present himself, within fourteen days from the date of this order, before the probation officer named herein, and will produce copies of the order and the bond executed by him;
(2)
that he will submit himself to the supervision of the Probation Officer or any other officer appointed in his place;
(3)
that he will (a) during the period specified herein, keep the Probation Officer advised of his place of residence and means of livelihood; (b) reside at ____________________ for a period of __________________
(4)
that he will not quit the district jurisdiction of ________________ without the written permission of the competent authority;
(5)
that he will not associate with bad characters or lead a dissolute life;
(6)
that he will live honestly and peaceably and will endeavour to earn an honest livelihood;
(7)
that he will not commit any offence punishable by any law in force in India;
(8)
that he will abstain from taking intoxicants;
(9)
that he will carry out such directions as may from time to time, be given by the Probation Officer, for the due observance of the conditions mentioned above.
Dated this _____________ day of _____________ 19_____
Judge or Magistrate.
Form VII
[See Rule 25]
[Under sub-section 4 of the Probation of Offenders Act, 1958]
In the Court of the _________________ Magistrate
Case No. _____________ of 19____
Whereas I, _____________________ inhabitant of _____________________ have been ordered to be released by the Court of _____________________ on condition of my entering into a bond to observe the conditions specified in the supervision order made by the Court, I hereby bind myself as follows:
(1)
that I will accept and fulfil the conditions specified by the Court in such order for the period specified therein;
(2)
that I will present myself, within fourteen days from the date of the supervision order, before the Probation Officer named in the order and will produce copies of the order and the bond executed by me;
(3)
that I will submit myself to the supervision of the Probation Officer named in the supervision order or any other officer appointed in his place;
(4)
that I will (a) during the period specified in the order, keep the Probation Officer advised of my place of residence and means of livelihood, (b) reside at _______________ for a period of ___________
(5)
that I will not quit the said district/jurisdiction of ______________ without the written permission of the competent authority;
(6 that I will not associate with bad characters or lead a dissolute life;
(7)
that I will live honestly and peaceably and will endeavour to earn an honest livelihood;
(8)
that I will not commit any offence punishable by any law in force in India;
(9)
that I will abstain from taking intoxicants;
(10)
that I will carry out such directions, as may from time to time, be given to me by the Probation Officer, for the due observance of the conditions mentioned above.
In case of my making default therein, I hereby bind myself to forfeit to Government the sum of Rupees ___________________________ Dated this ________ day of _____________ 19____.
(Signature) ________________