POLICE REPORT FORM 
  
To 
The Commissioner of Police 
18, Lalbaazar Street, 
Kolkata – 700 01, 
West Bengal, 
India. 
Sir, 
Sub: Request for Police Report 
1. Name of the applicant:  
2. Address of the applicant: 
  
3. Case No., Date, Section(s) of Law and Police Station:  
4. Purpose of the report: 
Yours faithfully, 
Note: 
a) Government fees to be deposited 
b) Xerox copies of required documents to be attached