PAYING GUEST INFORMATION (To be filled in capital letters only) 1. Landlord/owner information House no.__________________________Sector/Village_______________________ Name of Owner___________________Since____________Phone No.____________ Father/Husband Name_____________________Permanent Address____________________________________________ Distt.____________State______________ Police Station____________Phone No.___________Occupation ________________ Whether landlord residing in the house yes/no 2. Number of paying guests _____________________________________ PARTICULAR OF PAYING GUESTS I. Name of PG _____________________ s/o, d/o, w/o ____________________ PG since _______________________ Occupation _____________________ Place of work ____________________ Purpose of stay __________________ Telephone no. ___________________ Vehicle no. _____________________ Licensed weapon (Detail ) ____________________________________________ Permanent address __________________________________________________ Police Station _________________Distt.____________State_________________ II. Name of PG _____________________ s/o, d/o, w/o ____________________ PG since _______________________ Occupation _____________________ Place of work ____________________ Purpose of stay __________________ Telephone no. ___________________ Vehicle no. _____________________ Licensed weapon (Detail ) ___________________________________________ Permanent address _________________________________________________ Police Station _________________Distt._________State __________________ III. Name of PG _____________________ s/o, d/o, w/o ____________________ PG since _______________________ Occupation _____________________ Place of work ____________________ Purpose of stay __________________ Telephone no. ___________________ Vehicle no. _____________________ Licensed weapon (Detail ) ___________________________________________ Permanent address _________________________________________________ Police Station _________________Distt._________State __________________ FOR USE OF POLICE STATION Received on ___________________________ PS Diary ______________________________ Authorized signatory Name __________________________________ Rank ___________________________________
