Complaint Registration Form

Details of Complainant
Date of Filling
Name of Complainant
Telephone Number
Mobile Number
Email id
Official/Residential Address
Address
District
State
Pin Code
Details of Respondent
Name of Respondent
Telephone Number
Mobile number
Email Address
Official/Residential Address
Address
District
State
Pin Code
Details of Complaint
Subject of Complaint
Facts of Complaint
Relief(s) Sought

(Specify the ground of Relief & legal provision, if any relied upon)

Interim Order Required,If Prayed for

(Give With Reasons)

Fee Details
Amount
Name of the Bank
Demand Draft Number
I, the Complainant declares that the Subject matter of claims falls within Jurisdiction of Regularity Authority.
I,the Complainant further declares that the matter Regarding which this complaint has been made is not pending before any court of law or any other Authority or any other Tribunal(s).
I, the Complainant do hereby verify that the contents of details above are true to my personal knowledge and beleif and that I have not suppressed any material fact(s).