(Section 81, Cr. PC)
(Form No. 3 of Schedule 11, Cr. PC)

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……….. next, 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, I bind myself to forfeit to Government, the sum of Rs . ………… Dated this day of ……….20……….
……………………….
(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 next, 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
Fore felt, to Government the sum of Rs . ………
Dated this ………….day of … 20……….

Seal of the court ……………………
Signature