Police Report for Lost Item / Document - sample
Ramesh Kumar Sharma
son of Mohan Lal Sharma
12, Gandhi Nagar, Jaipur - 302015
Mobile: 98XXXXXX10
ID proof: Aadhaar ending 4821
Date: 13/11/2026
To,
The Station House Officer,
Police station name, city
Subject: Request to register a report of the loss of Samsung Galaxy mobile phone, black, IMEI 35XXXXXXXXXXXX1, SIM 98XXXXXX10 and to issue a copy (lost-article report / certificate)
Sir / Madam,
1. I, Ramesh Kumar Sharma, son of Mohan Lal Sharma, resident of the address above, respectfully state that I lost the following article on 26 September 2026, around 6 pm at / near near Junagarh Fort market:
| Article | Samsung Galaxy mobile phone, black, IMEI 35XXXXXXXXXXXX1, SIM 98XXXXXX10 |
|---|---|
| Approximate value | Rs. 18,000 |
| Date and time | 26 September 2026, around 6 pm |
| Place | near Junagarh Fort market |
2. Identification of the article.
- Make and model
3. Circumstances. It was in my pocket when I was shopping and I noticed it missing when I wanted to call home. The phone had a black cover and a cracked screen guard. I noticed the loss soon afterwards, and I searched the place and its surroundings, asked the nearby shopkeepers and people, and called the number to find the article, but I could not find it. At the time, my friend Mr. Arjun Singh was with me. I do not suspect any particular person.
4. Request. I request you to kindly register my report of the loss in the register of the police station, to give me an acknowledgement or a copy of the report with its number and date, and, if it is the practice, to issue a lost-article certificate. I need this to apply for a duplicate / replacement, to block the SIM / card / account, and to protect myself from any misuse of the article. If any case is registered for a wrong use of the article, it may please be noted that I am not responsible for it after the time of the loss.
5. Undertaking. I confirm that the facts stated above are true and correct to the best of my knowledge, and that I have not concealed any fact. If the article is found, I will immediately inform your office and the concerned authority. A copy of my ID proof and, wherever available, the purchase bill or the box of the article is attached.
I shall be thankful to you for your kind help.
6. Use of this report. I request that the acknowledgement may be given to me at once, as it is needed by the bank, the telecom company, the transport office or the issuing authority for the issue of a duplicate and for the protection of my rights. I understand that the report is only a record of my information, and I will cooperate if the police ask me for any further details.
Yours faithfully,
Ramesh Kumar Sharma
Signature: ____________________
Mobile: 98XXXXXX10
Enclosures: 1. Copy of ID proof 2. Copy of purchase bill / box / IMEI details (if available) 3. Any other proof of ownership. Received by the police station: ________________ (name, rank, date and seal)