PROFORMA

(to be appended with the Complaint U/s 138 NI Act)

IN THE COURT OF

1. Complainant:

2. Respondent(s)/Accused(s):

3. Particulars of Cheque:
A) Amount of Cheque: B) Date of Cheque:

C) Drawn on Bank: D) Branch:

E) Payee Bank: F) Branch:

4. Date of Dishonor:

5. Reason for Dishonor:

6. Date of Knowledge of Dishonor:

7. Date on which Notice Sent:

8. Date of Service(Actual):
(Deemed, if any):

9. Date of Filing Complaint:

10. Whether filed within the Statutory Limitation Period:

If NO, then Delay Condoned on:

11. Document Filed(Please Click)

I. Cheque:
II. Memo of Dishonor:
III. Copy of Legal Notice:
IV. Copy of Postal Receipt:
V. Copy of A.D. if any:
VI. Other, Please Specify: