FORM C

[see section 12(8)] Personal Bond of the Prisoner

In the Court of the District Magistrate, _____________________________________________

This bond is made on the _______________________ by __________________________ (Number, Name, Father’s Name and Address of the Prisoner). Whereas the Releasing Authority is pleased to order my release on emergency parole/regular parole/furlough for a period of _____________ (period of release) under section 3 or 4 or 5 of the Haryana Good Conduct Prisoners (Temporary Release) Act, 2022, on conditions of my furnishing a personal bond and a surety bond, each for a sum of Rs.__________________ to observe the condition specified below. Now, therefore, I do hereby bind myself to faithfully observe all the conditions mentioned here below and in case of my making default in observing any of them, I bind myself to forfeit the State Government the sum of Rs.___________________ .

(1) I shall during the period of my temporary release reside at _________________________________ (complete address) and shall not without obtaining the permission of the District Magistrate, ______________, visit any place not specified in the release warrant.

(2) I shall during the period of my temporary release keep peace and maintain good behavior.

(3) After the expiry of the period of _______________________ (period of release) for which I have been temporarily released, I shall surrender myself to the Superintendent Jail, _____________ Jail, ___________________ to undergo the unexpired period of my sentence.

(4) In case my sureties becomes insolvent or dies, I shall furnish fresh security immediately.

Signature and thumb impression of the Prisoner

Accepted for and on behalf of the Releasing Authority.