(See Regulation 12)

NATIONAL HUMAN RIGHTS COMMISSION

(Law Division)

                                                                                                                Case No. ______________________

                                                                                                                (To be given after registration)

Code:                                                                                                      CLASSIFICATION:

SECURITY REPORT

Diary No. _________________ / NHRC

Name of the complainant:

Is it a public interest complaint:

Date of cause of action / incident:  

The State and District to which the incident relates:  

Whether the complaint is directly addressed to the Commission; or

Whether only a copy thereof is endorsed to the Commission:

In case of suo motu action, the source of information; vis-à-vis news item; or

other source (Give brief particulars):

Name, designation and address of the public servant by whom alleged violation of human right was committed / abetted or who was negligent in prevention of such alleged violation:

                (i)

                (ii)

                (iii)

(Note:  If the complaint relates to Armed Forces, here specifically indicate the Ministry / Department of the Central Government under which such Armed Forces come.)

Name, designation and address of the authority from whom information / report may be called for:

                (i)

                (ii)

(Note:  In case of Armed Forces, Naval, Military and Air Force coming under Defense Ministry, information be called from the Secretary of that Ministry and in case of other Armed Forces of the Union, from the Secretary of Home Ministry.)

Gist of the complaint / suo motu action (here give grief account of the matters referred to in the complaint / suo motu action):

Is there any complaint / action pending / disposed of on the same subject matter / incident: 

(If yes, give case number and other relevant information and append the record of such case)

Relief, if any, sought:

                                                                                                                                (Signature)

                                                                                                                                ASSISTANT REGISTRAR

                                                                                                                                 Date:

NOTE:

If there are more than one complainant, give only the name of the first complainant.

If the information in regard to any column is not available, put “N.A.” against that column.

Information in regard to column 11 shall be ascertained from the computer.