FORM
(See rule 3)
Report of Violence / Damage or Loss to Property in Medical Service Institutions
1. Details of complainant / Aggrieved person:
(a) Name:
(b) Designation:
(c) Present Address:
(d) Permanent Address:
(e) Phone Number:
2. Details of Medical Service Institution:
(a) Name:
(b) Address:
(c) Sector (Government / Private / Corporate / Local body):
3. Details of incident:
(a) Date on which incident occurred:
(b) Place of incident:
(c) Name of persons involved in violence and damage or loss of property:
(d) Nature of violence:
(e) Details of damage or loss to property:
(f) Approximate cost of damage or loss incurred to property:
4. List of Document(s) attached:
5. Assistance:
(a) Police assistance, if any, needed by the complainant or aggrieved person(s):
(b) Assistance for initiating criminal proceedings and legal aid needed:
6. Instructions for the police assisting in registration of a violence and damage or loss report:
Section 15 • THE ARUNACHAL PRADESH PROTECTION OF MEDICAL SERVICE PERSONNEL AND MEDICAL SERVICE INSTITUTIONS (PREVENTION OF VIOLENCE AND DAMAGE OR LOSS OF PROPERTY) ACT, 2019
Form
arunachal-pradesh-protection-of-medical-service-personnel-and-medical-service-institutions-prevention-of-violence-and-da-sec-15.json
•
Section 15
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"act_title": "THE ARUNACHAL PRADESH PROTECTION OF MEDICAL SERVICE PERSONNEL AND MEDICAL SERVICE INSTITUTIONS (PREVENTION OF VIOLENCE AND DAMAGE OR LOSS OF PROPERTY) ACT, 2019",
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"content": "FORM\n(See rule 3)\nReport of Violence / Damage or Loss to Property in Medical Service Institutions\n\n1. Details of complainant / Aggrieved person:\n(a) Name:\n(b) Designation:\n(c) Present Address:\n(d) Permanent Address:\n(e) Phone Number:\n\n2. Details of Medical Service Institution:\n(a) Name:\n(b) Address:\n(c) Sector (Government / Private / Corporate / Local body):\n\n3. Details of incident:\n(a) Date on which incident occurred:\n(b) Place of incident:\n(c) Name of persons involved in violence and damage or loss of property:\n(d) Nature of violence:\n(e) Details of damage or loss to property:\n(f) Approximate cost of damage or loss incurred to property:\n\n4. List of Document(s) attached:\n\n5. Assistance:\n(a) Police assistance, if any, needed by the complainant or aggrieved person(s):\n(b) Assistance for initiating criminal proceedings and legal aid needed:\n\n6. Instructions for the police assisting in registration of a violence and damage or loss report:",
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}