After Form IX of the said rules, the following forms shall be inserted, namely:- GOVERNMENT OF KARNATAKA Form No.X (See rule 191(2)(c) BOND Whereas I, prisoner No…………………………… S/o……………….………… resident of …………..………. village……………….…… District have been sentenced to undergo imprisonment for a term of ….. years and where as the inspector General of Prisons, Karnataka State has been pleased to release me on parole for a term of…..…………… commencing from ………………… and ending on …………………..on condition of my executing a bond with two sureties undertaking that I will return to the prison before the expiry of the period of my temporary release, and that I will maintain good conduct and will not associate with any bad element or commit any offence punishable by any law during that period.
I hereby agree and bind myself to comply with all the aforesaid conditions during the period or extended period of parole and in case of my making default therein, I bind myself to forfeit to the Government a sum of Rs………….. and I agree that the Government may without prejudice to any other rights or remedies recover the said sum from me as arrears of land revenue.
Dated this ………………..day…………………….of……………..20…….
Before me Superintendent of ……………………….Prison Signature of Prisoner We 1) ……………………………………………………………………son of resident of …………………..village……………………..taluk……………………………….District and 2) ……………………………….………………son of ………………………………….resident ourselves sureties for the above said prisoner No…………………………. confined at the prison and give the guarantee that he will return to the prison before the expiry of the period of his temporary release, and that he will maintain good conduct and will not associate with bad element or commit any offence punishable by any law during that period or the extended period of his temporary release, and in case of his making default therein we hereby bind ourselves to pay to the Government of Karnataka the sum of Rs………………….. (in words also)…………… and we agree that the Government of Karnataka may without prejudice to any other rights or remedies open recover from us the said sum as arrears of land revenue.
Dated this…………………………………. day of ……………………….20…..
1) 2) Signed by the above named………….. (Signature of sureties) Sureties in the presence of:
1.
2.
Before me Superintendent of ……………….. Prison 4 GOVERNMENT OF KARNATAKA (Form No.XI) (Rule 191 (3)(c) Prisons Department To, The Superintendent of Prisons, ……………………………………...
Sir, I Prisoner No…………..…..S/o …………………………. Permanent resident of……………………village………………….Taluka……………….
………………………….District………………………………..confined in………………… jail …………………… hereby apply for grant of emergency parole for………days to go to ………………………. village……………… …………………Taluka…………………..District……………. for attending the last rites of…………………………………. who is my ………………………………………./for visiting…………….who is my……………………….
and who is terminally ill (on account of disease, accident or other reasons)/ for attending the marriage of ………………….. who is my ……………………….
I have served………………………………….. years of sentence.
I shall go at my own cost.
I am not a habitual prisoner.
I am agreeable to deposit cash of Rs.6,000/- as security or to furnish two sureties for a sum of Rs.3000/- each. My sureties are:
1……………………………… Yours faithfully, …………………………….....
2……………………………… (Signature of the prisoner) ………………………………..
Before me, ………………………………..
Superintendent, ……………………… Jail By Order and in the name of the Governor of Karnataka G.K.GURANI Under Secretary to Government, Home & Transport Department, (Prisons and Cinema)