SHORT TERM PLACEMENT PENDING INQUIRY

FORM X

[Rule 27(18)]

ORDER OF SHORT TERM PLACEMENT PENDING INQUIRY

Name of the child                                                            :

Sex                                                                                 :

Age                                                                                 :

Father’s Name                                                                 :

Mother’s Name                                                                :

Address                                                                           :

Date of receiving by organization/Institution:

Produced by:

This is to authorize and direct you to receive the said child in your charge, and keep her/him in the Shelter Home/Children’s home for care and protection under section 33 (1) of the J.J. Act,2000.

Next Date:

                                                                                                      (Signature)

Chairperson/Member 
 Child Welfare Committee