FORM D

Surety Bond

In the Court of the District Magistrate, ______________

This Bond is made on the __________________________ by __________________________________ (1st surety) and _______________________________ (2nd Surety) (hereinafter collectively referred to as the “Sureties”). (Number of sureties as decided by the releasing authority); Whereas the releasing authority is pleased to order the release of ________(Number, Name, Father’s Name and address of the prisoner) (hereinafter referred to as the “prisoner”) on emergency parole/regular parole/furlough for a period of ________ Weeks) under section 3 or 4 or 5 of the Haryana Good Conduct Prisoners (Temporary Release) Act, 2022, on the condition of the prisoner furnishing a bond as well as a surety bond each for the sum of Rs. ____________________ to observe the conditions on which the prisoner has been temporarily released; And whereas the prisoner has on _________ (date of execution of personal bond of the prisoner) executed a personal bond for the sum of Rs.____________________ to observe the conditions specified therein. Now, therefore, the sureties jointly and severally do hereby bind themselves to forfeit to State Government the sum of Rs. __________________ in case the prisoner makes a default in observing any of the conditions specified in the warrant for temporary release.

Signature of the First Surety.

Signature of the Second Surety.

Accepted for and on behalf of the Releasing Authority