| (Regulation 10(2)) |
| ––––––– |
| Discipline Form |
| Charge Against Name ................................................ No ................................... |
| Rank ...................................................Rate of Pay .......................................... |
| CHARGE |
| Particulars of Offence | Names and addresses of witnesses in support of charge and whose statements are attached |
| 1 ............................................. |
| 2 ............................................. |
| 3 ............................................. |
| 4 ............................................. |
| 5 ............................................. |
| 6 ............................................. |
| Questions to be answered by defaulter |
| 1. | Do you admit or deny the charge? |
| 2. | Do you wish— |
| (a) | to select a police officer to assist you in presenting your case? |
| If so, give his or her name, rank and number. If not write “No” .................. |
| (b) | the Commissioner of Police to take steps with a view to securing the attendance of any witnesses for you at the hearing of the case? |
| If so, give their names and addresses. If not, write “None”. |
| .................................................................................................... |
| .................................................................................................... |
| .................................................................................................... |
| .................................................................................................... |
| .................................................................................................... |
| .................................................................................................... |
| Date ................................. | Signature of defaulter ......................................... |
| Hearing |
| Date ........................... | Time ........................... | Place ............................ |
| and by adjournment on— |
| Date ...................... | Time .................. | Place ..................... |
| Notified to defaulter |
| ................................................ |
| Signature of Officer taking case. |