Section 175(3) BNSS Application Format to Magistrate for FIR

Replace everything in [square brackets] with your own details. Delete lines that do not apply.

IN THE COURT OF THE [CHIEF JUDICIAL MAGISTRATE / JUDICIAL MAGISTRATE FIRST CLASS / METROPOLITAN MAGISTRATE], [PLACE], [DISTRICT], [STATE]

Criminal Miscellaneous Application No. ______ of [YEAR]

IN THE MATTER OF:

[FULL NAME OF APPLICANT]
S/o / D/o / W/o [FATHER'S OR SPOUSE'S NAME]
Aged about [AGE] years
R/o [FULL ADDRESS]
Mobile: [MOBILE NUMBER]
... Applicant / Complainant

Versus

1. [NAME OF PROPOSED ACCUSED NO. 1]
S/o / D/o / W/o [NAME]
R/o [ADDRESS]

2. [NAME OF PROPOSED ACCUSED NO. 2, IF ANY]
R/o [ADDRESS]
... Proposed Accused

Police Station: [NAME OF POLICE STATION], District [DISTRICT]

APPLICATION UNDER SECTION 175(3) OF THE BHARATIYA NAGARIK SURAKSHA SANHITA, 2023 FOR A DIRECTION TO THE OFFICER IN CHARGE OF POLICE STATION [NAME] TO REGISTER AN FIR AND INVESTIGATE

MOST RESPECTFULLY SHOWETH:

1. That the applicant is a resident of the address given above. The offence described below was committed at [PLACE], within the local limits of Police Station [NAME] and within the jurisdiction of this Hon'ble Court.

2. That [STATE THE FACTS IN THE ORDER THEY HAPPENED — dates, amounts, documents, and the specific role of each proposed accused].

3. That the above facts disclose the commission of cognizable offences punishable under Sections [SECTIONS, e.g. 318(4), 316(2), 351(2), 3(5) OF THE BHARATIYA NYAYA SANHITA, 2023 AND/OR SECTIONS OF ANY OTHER ACT]. [IF THE OFFENCE WAS BEFORE 1 JULY 2024, CITE THE CORRESPONDING IPC SECTIONS.]

4. That on [DATE], the applicant gave a written complaint to the Station House Officer, Police Station [NAME], under Section 173(1) of the Sanhita. The complaint was received [VIDE DIARY / GD NO. [NUMBER] / BY POST, DELIVERED ON [DATE]]. A copy, with proof of delivery, is annexed as Annexure A-1. [STATE WHAT HAPPENED: no FIR was registered / the SHO refused orally on [DATE] / the applicant was told to settle the matter].

5. That on [DATE], the applicant sent the substance of the information in writing, by post, to the Superintendent of Police, [DISTRICT], under Section 173(4) of the Sanhita. It was delivered on [DATE]. A copy, with postal receipt and tracking report, is annexed as Annexure A-2. [STATE: no action was taken till date / the SP forwarded it to the same police station but no FIR was registered / reply dated [DATE] is annexed as Annexure A-3].

6. That despite the above, no FIR has been registered, though the information plainly discloses cognizable offences. The applicant has thus availed the remedies under Section 173 of the Sanhita and is constrained to approach this Hon'ble Court.

7. That police investigation is necessary because [STATE WHY — e.g. the accused's identity and bank accounts need to be traced / the stolen property must be recovered / the documents are in the custody of the accused or third parties].

8. That [THE PROPOSED ACCUSED IS NOT A PUBLIC SERVANT] [OR: proposed accused no. [NUMBER] is a public servant, and the applicant submits that the act complained of [DID NOT ARISE / AROSE] in the course of official duty; the applicant requests that the procedure under Section 175(4) of the Sanhita be followed, if applicable].

9. That the applicant has not filed any other application or complaint on the same facts before any court, except [DETAILS, IF ANY].

10. That this application is supported by the affidavit of the applicant.

PRAYER

It is therefore most respectfully prayed that this Hon'ble Court may be pleased to:

(a) call for a report or submissions from the Station House Officer, Police Station [NAME], as provided in Section 175(3) of the Sanhita;

(b) direct the officer in charge of Police Station [NAME] to register an FIR on the applicant's complaint dated [DATE] and to investigate the case in accordance with law; and

(c) pass any other order that this Hon'ble Court considers just and proper.

Applicant / Complainant
Through Counsel

[ADVOCATE'S NAME]
Advocate, Enrolment No. [ENROLMENT NUMBER]
[CHAMBER ADDRESS]
[MOBILE NUMBER] | [EMAIL]

Place: [PLACE]
Date: [DATE]

LIST OF ANNEXURES
Annexure A-1: Copy of complaint to SHO dated [DATE], with receiving or proof of delivery
Annexure A-2: Copy of complaint to Superintendent of Police dated [DATE], with postal receipt and tracking report
Annexure A-3: Reply of the police, if any
Annexure A-4 onwards: [SUPPORTING DOCUMENTS — agreements, bank statements, messages, photographs, medical papers]

AFFIDAVIT

I, [FULL NAME OF APPLICANT], S/o / D/o / W/o [NAME], aged about [AGE] years, R/o [FULL ADDRESS], do solemnly affirm and state as under:

1. That I am the applicant in the accompanying application under Section 175(3) of the Bharatiya Nagarik Suraksha Sanhita, 2023, and I am fully acquainted with the facts of the case.

2. That the contents of paragraphs 1 to 10 of the accompanying application have been drafted on my instructions and are true and correct to my knowledge.

3. That I gave a written complaint to the SHO, Police Station [NAME], on [DATE], and sent the substance of the information to the Superintendent of Police, [DISTRICT], on [DATE], and no FIR has been registered.

4. That the annexures are true copies of their originals.

5. That I understand that making a false statement in this affidavit is a punishable offence.

DEPONENT

VERIFICATION

Verified at [PLACE] on [DATE] that the contents of paragraphs 1 to 5 of this affidavit are true and correct to my knowledge, no part of it is false, and nothing material has been concealed.

DEPONENT
[SWORN BEFORE THE OATH COMMISSIONER / NOTARY]