(See sections 106 and 107, Cr. PC)
(Form No. 12, Schedule 11, Cr. PC)

WHEREAS I (name) . inhabitant of (place), have been called upon to enter into a bond to keep the peace for the term of……….. or until the completion of the inquiry in the matter of now pending in the Court of I hereby bind myself not to commit a breach of the peace, or do any act that may probably occasion a breach of the peace during the said term or until the completion of the said inquiry and in case of my making default there in, I hereby bind myself to forfeit to Government the sum of Rs . ……..

Dated this……….day of……….20……….
………………………….
Signature
Seal of the court