IN THE COURT OF _______, SESSIONS JUDGE, ____
In the matter of :
____ Versus ______
FIR No. ______
U/S : ____ IPC
P.S. ____ District ____
Next Date of Hearing – ____
APPLICATION FOR SURRENDER OF THE ACCUSED/APPLICANT ______
1- That the above noted case is pending adjudication in this Hon’ble court and is fixed for ____.
2- That the applicant/accused moved an application for interim bail on _____ before this Hon’ble court and this Hon’ble court was pleased to release the accused on interim bail vide order dated _____ for the period upto ____.
3- That the ___ of the ____ of the applicant/accused namely ____ is _____. The copy of the medical certificate issued by ____ has already been placed on record on ____. It is further submitted that the applicant/accused appeared before this Hon’ble court on____ and the case was adjourned for ____.
4- That now the applicant is surrendering herself today before this Hon’ble court.
It is, therefore, most respectfully prayed that the surrender of the accused may kindly be accepted and she may kindly be taken into custody.
Dated ______ APPLICANT/ACCUED
_____ S/o ____ R/o ______