Code of Criminal Procedure 1973 , FORM NO 30

FORM NO. 30. Special Summons to a Person Accused of a Petty Offence

WHEREAS your attendance is necessary to answer a charge of a petty offence………………(state shortly the offence charged), you are hereby required to appear in person (or by pleader) before ……………………. (Magistrate) of…………… on the…….. day of …………. .19………. or if you desire to plead guilty to the charge without appearing before the Magistrate, to transmit before the aforesaid date the plea of guilty in writing and the sum of ………… rupees as fine, or if you desire to appear by pleader and to plead guilty through such pleader, to authorise such pleader in writing to make such a plea of guilty on your behalf and to pay the fine through such pleader.

Herein fail not. Dated, this …………… day of………………… 20……….

(Seal of the court)