1. In the court of Sh. …………………………………….
State through Govt. Food Inspector
…… Complainant
Versus
……………………………………………………………………………………………. Accused
……………………………………………………………………………………………..
Complaint u/s 7/16 of Prevention of Food Adulteration Act.I.954 and U/r 24 & 50 of the PFA. Act .Rules
1.955
Sir,
The Complaint respectfully submits as under:-
1.That I, ............................................, complainant have been appointed as Govt. Food Inspector vide
Punjab Govt. Gazette Notification No. ..................... dated................. and have been authorized to
Institute prosecution under the Prevention of Food Adulteration Act, 1954 vide Punjab Govt.
Notification No....................... dated .............
Annexure as I & II.
2 That on ……………. I, the complaint inspected the premises of ………………………….
………………………………………………………………………………………………………where the accused was having about
………………………………………. for sale to the Public for Human consumption.
3 That I disclosed my identity to the accused as Govt. Food inspector and showed my intention to take
the sample of ………………………………………………… for analysis as he was selling to the Public. Then I the
complainant served the accused a notice on form No. VI in writing which was duly signed by the
accused and by me and also by Sh ............................................................................................ A request
was made to the persons in public for joining the proceedings of sampling but none agreed to join
One copy of the form no. VI was duly received by the accused.
Annexure as III
cont.page2

2. 4 That I the complainant purchased ……………….. on the payment of Rs./-…………. against a valid receipt.
The receipt was signed by the accused and by me and also by
Sh/Dr………………………………………………………………………. Annexure as IV
5 That the purchased Sample portion was drawn after making complete homogenizing the whole bulk
quantity ………….. Kg with the help of a neat, clean & dry glass rod / knife and then added the
prescribed quantity of preservative into the purchased sample portion which was further divided into
three equal parts Each sample portion was labeled , fastened and wrapped in a strong thick paper. The
edges of strong thick paper were pasted on the sides of each sample portion with the help of gum. A
paper slip having Serial No. …………………… LHA Code No. ………………………..duly signed by the Local
(Health ) Authority , ............... was pasted on the each sample portion. With the help of gum lengthwise
covering the mouth of each sample and was further secured by means of strong thread then each
portion was sealed at the spot at five distinct places bearing the seal impression as “ ”. Then the
signature of the accused was taken partially on the paper slip of L.H.A. and partially on the wrapper of
each sample portion and I also signed on each sample portion in the similar manner.
6 That the spot memo was prepared at the spot which was duly signed by me and the accused and also
by Sh/Dr.………………………………………………………………………
Annexure as .V
7 That on reaching the office of Local Health Authority, ................... on the same day in evening I
prepared five copies of Memorandum of Form VII and three seal impressions of the seal used to seal
sample portions were affixed upon it.
Annexure as VI
8 That one sealed sample was send to the Public Analyst, Punjab Chandigarh along with a copy of
Memorandum of Form No. VII bearing the seal impression of the seal used, in a sealed packet on the
same day in the evening for analysis through Special Messenger Shri …………………………(class IV) O/o Civil
Surgeon, …………………… The Affidavit is of special messenger is
Annexure as VII
9 That a separate sealed envelop containing form No. VII bearing seal impression of seal used was also
sent to the Public Analyst Pb. Chandigarh through the same special messenger. That the remaining
sealed sample portions and Form VII were deposited at the office of LHA. ………………………. the same day
evening. .
. .
Cont.pg..3
10 That I, the complaint received the report of the Public Analyst, Pb. Chandigarh through the L.H.A.
Gurdaspur. The opinion of Public Analyst is below:

3. …………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………… Annexure as VIII
11. That the .accused has committed offence under the Prevention of Food Adulteration Act,1954
action may kindly be taken against him under section 7/16 of PFA,Act,1954.and under rule 50 of PFA,
Rules 1955 by stocking …………………………… for sale to public for human consumption without any valid
license It is further prayed that since this offence facts under section 16 which shall be tried In summary
trial procedure as said under section 262-265 of Cr.PC.1973.
12. That accused Sh. …………………………………………….
………………………………………………………………………………………………………………………………being the in charge
and responsible person work and conduct of the business has committed offence under the
Prevention of Food Adulteration Act,1954 ,action may kindly be taken against him under section 7/16 of
PFA,Act,1954.and under rule 50 of PFA, Rules 1955 by stocking cow Milk for sale to public for human
consumption without any valid license It is further prayed that since this offence facts under section 16
which shall be tried In summary trial procedure as said under section 262-265 of Cr.PC.1973
The complaint is here by submitted for disposal in accordance with law, please-
That the complainant being a Public Servant have to perform multifarious duties and is unable to
attend this Hon’ble Court on each and every date of hearing of this case, hence my presence on each
and every date of hearing of this case may kindly be exempted and A.P.P. attached with the Hon’ble
Court may be allowed to appear on my behalf. However I may be summoned as and when so required.
Complainant
(Govt. Food Inspector)
Cont pg ..4
List of Witnesses
1.Complainant -------------------------------------, G.F.I. O/o Civil Surgeon,………
2 Dr./ Sh. -------------------------------------------------

4. 3.Sh. -------------------------------, Dealing Food Clerk, O/o Civil Surgeon .............
4.The Public Analyst, Pb. Chandigarh.
5. Sh. ______________________ SSK O/o Civil Surgeon, ......................
6. Any other Witness by Hon’Ble Court
Annexure (List of documents attached)
1.Complaint in two copies.
2.Copy of Notice on Form No. VI is Annexure -
3.Spot Memo. is Annexure -
4.Payment Receipt is Annexure -
5.Report of Public Analyst, Punjab, Chandigarh is Annexure -
6.Form VII is Annexure-
7.Photocopies of Notifications of complainant. is Annexure -
8.Affidavate of Special Messenger is Annexure -
9.(Any other) is Annexure-
. .
complainant
Govt. Food Inspector