Complain Registration Form

Complainant Info Name Mr./Ms. :  * Contact Number : Address :  * Contact E-mail :

Reporting To Department: ---Select--- Administration Revenue Health and Sanitory Legal Accounts Engineering Urban Development Post Retiral Benefit Promotion Retiral Benefit Group Insurance Civic Amenities Pensionery Provident Fund D.A Compasionate Ground Civic Center Property Report  * Ward Number : Office :  * Addressed To :  * CC To :  * Officer :

Complain Type Complain Type : ---Select--- GENERAL SERVICE OTHERS  * Sub Type of Complain :  * Other Complain Type :   Any Old Complain already given : Yes No If Yes,Complain Number : Relevant Information like meter no etc. :

Complain Description Complain Description :(Max of 750 Chars)  * 750 Characters Left