Informer Incentive Scheme

Sex determination Sex selection - pre-conception Sex selection - pre-natal Illegal/unregistered ultrasound facility Illegal use of portable/mobile ultrasound machine Misuse of a registered ultrasound facility Abetment/assistance in sex determination or sex selection Coercion/pressure on a woman for sex determination/selection Suspected manipulation/falsification of records Unlawful possession/use of ultrasound equipment Suspicious referral suggestive of sex determination/selection Suspicious pattern of visits/referrals suggestive of possible sex determination/selection Suspected person impersonating a doctor/medical professional Sex-selection-linked illegal abortion/MTP Illegal advertisement/publicity relating to sex determination/selection Any other PC & PNDT violation

Type *

Clinic / Centre / Facility Name *

Person(s), if known

Qualification / designation

Vehicle number, if any

Address / location / landmark *

State * Odisha Other

Area Classification * Urban Rural

State *

District / Urban Area *

Block / ULB

Village / Ward

PIN Code *

Police station

Google map / location link

Date / period

Approximate time

Pregnant women / persons observed

Brief description of suspected activity / information *

How was information obtained?

Urgency

Photograph Video Audio Recording Prescription Ultrasound Report Referral Slip WhatsApp Message Payment Receipt Vehicle Details Witness Available Advertisement / Visiting Card Other

Up to 5 files; 5 MB each.

Reported earlier?

Previous reference / details, if known

Name

Village / ward

Mobile

Occupation / category

Preferred communication

Informer Incentive Scheme - Information Reporting Form

1. Type of Suspected Violation *

2. Details of Centre / Person / Activity

Patient Address Details

3. Details of Suspected Violation

4. Evidence / Supporting Information Available

5. Previous Reporting

6. Confidential Informer Details

7. Mode of Reporting

8. Declaration by Informer