File a Complain

 

Name of the Complainant  *
Complainant's Address
Email Address *
Phone  *
Against whom there is a complaint Full Name&Addres *
Opponent Phone number
E-mail / Website
Day and place of the incident
Full details of the complaint
Details of the action taken
How much is the loss?  *
Attachments
Maximum File Size (10240KB)
File Extension Type (doc,docx,odt,pdf,txt,png,jpeg,jpg)
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Department 
Priority  *
Terms and Conditions*
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