I (name) ___________ of ___________ being brought before the District Magistrate of ______________ (or as the case may be) under a warrant issued to compel my appearance to answer to the charge of ____________ do hereby bind myself to attend in the court of ____________ on the _____ day of ________, 2000, to answer to the said charge, and to continue to attend until otherwise directed by the court, and in case of my making default herein, 1 bind myself to forfeit to Government, the sum of Rs. _________.

Dated this ________ day of __________ 2000.

(Signature)

I, do hereby declare myself surety for the above named ______________of ____________ that he shall attend before ________________ in the court of _______________ on the ____ day of __________, 2000, to answer to the charge on which he has been arrested, and shall continue to attend until otherwise directed by the court and in case of his making default therein, I bind myself to forfeit, to Government the sum of Rs. ___________.

Dated this ______ day of ____________, 2000

Signature