Crisis Intervention Centres(CICs) Performa

1. Victims 

• Case File No.:
• Date of Reporting:
• FIR No. & Sections of IPC:
• Police Station:
• Referred by:
• Name of the Investigation Officer:
• Date of Visit:

• Name:
• Daughter of:
• Date of Birth & Age:
• Religion:
• Caste:
• Communication Address:
• Permanent Address:
• Telephone No.:
• Educational Status:
• Means of Livelihood:

• Urban Locality/Urban Village/Slum:
• Own/Rented/Any other:
• Number of rooms in the house

• Name of the Accused:
• Age:
• Address:

• Means of Livelihood:
• Was he accused before:
• If known :
• Nature of the rape:
• Place of Rape:
• Any other detail:

• Is the Accused Arrested:
• Medical done:
• Details of the evidence collected :

• Intervention required in the area of :
• Health :
• Education :
• Legal :
• Vocational Training :
• Support Services i.e. Shelter/Marriage/Financial Assistance) :
• Counseling Services, CICs Team, -(Individual/Family):