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FORM 2A
(FORMAT OF POLICE COMPLAINT)
Date: *___________
To
Police Station In-charge
*___________________
___________________
___________________
Reg: Request for registering Complaint - Mobile *IMEI No (Kindly mention both IMEI if handset is dual SIM).
IMEI No:
Make - Model -
Dear Sir,
I regret to inform you that my above mentioned Mobile Phone purchased vide Invoice No *______________ dated
____________, bearing IMEI No. * ____________________________________________________________ has
been stolen on *________________ (please mention date of incident)
Brief Description of Incidence:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
__________________________________________________________________________.
I was having PRE-PAID / POST-PAID facility and was using the services of Service Provider (please mention
service provider like Vodafone, Airtel, BSNL etc) *___________________ and my mobile number for same was
(please mention Mobile No.) *______________________. I have already informed the service provider to terminate
the services (incoming & outgoing)
Please register a complaint for the above mentioned stolen mobile and assist us in tracing the same at the earliest.
As soon as the said mobile is recovered, kindly inform to THE NEW INDIA ASSURANCE COMPANY LIMITED,
CHANDIGARH, Divisional Office, SCO 104-106, 1st Floor, Sector 34 A, Chandigarh with whom I have filed an insurance claim.
Thanking you
Signature of the Insured
Address:
Seal & Signature of Police Station
*NAME:
*DESIGNATION:
*PHONE NUMBER:
Place:
Date:
* Compulsory fields