Grievance Registration Form

CITIZEN CORNER

(Entries prefixed with * must be filled)


Grievance Pertains to
Select Type*

Folio Number *
Name *
Complainant Category *
Do You want to have a
Password for this Grievance?
Password*
Address 1*
Address 2
City/Town*  
Pincode*
Country *
Phone No.
(ISD Code+STD Code-without '0' prefix+Tel.No) eg : 911100000000
Mobile No.*
(ISD Code & Mobile Number)eg : 919999999999
Email Id.

Please enter Grievance Description upto 4000 characters *
Have you earlier lodged the grievance to
the above organisation on the same subject?

*Please type the characters appearing in the image below:
 
Enter the above characters*

  I hereby state that the facts mentioned above are true to the best of my knowledge and belief.
  
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