GRIEVANCE REDRESSAL FORM
Please Enter Personal Details (You Should Fill Up The Entries Prefixed With *)
*Applicant Name
Sex
Male
Female
Group
*Address
Phone No
Pincode
Email
Department to which Grievance related
Sanitation
Cleaning of drain and nalas
Repair of road
Encrochment of road
NOC for building constructions
House Tax/muitation/Assessment copy
registration of birth/death date
Water Connection/Sever Connection
Water Tax
any other complains
Subject Of Grievance
Complaint
Laying of Sewerage Lines
If another grievance which is not in list
Please Complete The Following Entries Before Submitting The Grievance Form
Have you exhausted the normal administrative channels of the department
No
Yes
Letter Number (if any)
Letter Date (DD/MM/YYYY)
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MONTH
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YEAR
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officer of the dept
Complaint
Laying of Sewerage Lines
Department
Complaint
Laying of Sewerage Lines
Designation(if others)
What was the response?
No Response
Claim Rejected
Under Consideration
Not Attended
Reply Incomplete
Reply Factually Incorrect
Is it subjudice?
Yes
No
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