FORM E

[see section 12(9)] Certificate of conditional release In exercise of the powers conferred by section 3/4/5 of the Haryana Good Conduct Prisoners (Temporary Release) Act, 2022, the Releasing Authority, subject to conditions hereinafter setforth, hereby directs the release of prisoner ______ (Number, Name, Father’s Name and Address of the prisoner), at present confined in _____, Jail, ________, for _______ (period of release) in pursuance of warrant, dated _______ (date of warrant of Releasing Authority). He has been permitted to visit the below noted places following the specified route:- Proceed from _________ Jail,_____, to __________ (full address) Return from ______ (full address) to ______ Jail,________ Conditions to be observed by the released prisoner:- 1. The prisoner shall proceed forthwith to __________ (full address). 2. He shall report back to _______Jail, _____ on _________ (date and time of surrender). 3. He shall not proceed to any place other than those he has been authorised to visit. 4. He shall keep peace and maintain good behavior during the period of his temporary release. 5. If in the opinion of Releasing Authority, he is found to have committed a breach of any of these conditions, it may cancel his release warrant and direct his re-admission to the jail. It is certified that the conditions specified in the above said temporary release warrant have been read over to the prisoner, he understands and acknowledge them and admit that he is being temporarily released on the above mentioned conditions . I received directions to be present at Jail, ______ on ______(date of surrender). Thumb impression of the Prisoner I believe that the prisoner understands the conditions and acknowledge them. Attested Date of temporary Release: (_____) Deputy Superintendent Prison _______, Jail, _________ No. Dated A copy of the above is forwarded to the following for information and further necessary action please:- 1. The Divisional Commissioner, _____ Division, ________ w.r.t. _____ (Release Warrant). 2. The District Magistrate, _____ w.r.t. _____ (orders regarding acceptance of sureties). (Personal bond and surety bonds of the prisoner are enclosed). 3. The Superintendent of Police, ______ with a request to direct the concerned SHO to keep a close watch on activities of said prisoner during the period of temporary release. 4. S.H.O. P.S., ______ District, _____. A close watch shall be kept on activities of said prisoner during the period of temporary release and submit a report as per sub-section 10 of Section 12 of the Act. Superintendent Jail, ______ Jail, _____.