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Online Complaint Form

All star (*) marked fields are compulsory.
District : Block :
Name (*): Email :
Mobile No : Scanned Document of ID with Address Proof :
(.jpg/.pdf only)
Subject (*): Document of Incident /Complaint :
(.jpg/.pdf only)
Date of Occurrence (*): Place of Occurrence (*):
Against whom complaint is made (*):
Brief description of the complaint: (1000 characters) (*)