Complaint Registration Form

Details of the Complainant

Name of Complainant^*

Telephone Number

Mobile Number^*

EmailId ^*

Signature:

Official/Residential Address

Address line 1^*

Address line 2^*

State^*

District^*

Pin Code^*

Address for Service of All Notices Same as above

Address line 1^*

Address line 2^*

State^*

District^*

Pin code^*

Details of the Respondent

Name of Respondent ^*

Telephone Number

Mobile Number^*

Email Address^*

Official/Residential Address

Address line 1^*

Address line 2^*

State^*

District^*

Pin Code^*

Address for Service of All Notices Same as above

Address line 1^*

Address line 2^*

State^*

District^*

Pin Code^*

Details of the Complaint

Subject of Complaint^*

Facts of Complaint^*

Relief Sought from RERA^*

Interim Order Required^*

Yes No

SupportingDocuments

DELETE

Caption:

Attachment:

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Payment

Payment Mode^*

Bank Name^*

Amount (INR)^*

Branch^*

DD/ Cheque No.^*

Attach Scan Copy^*

Declarations

I, complainant, here by declare that the subject matter of the above claim falls within the Jurisdiction of the Authority
I, complainant, here by declare that the matter regarding which the complaint has been made is not pending before any Court of Law or any other Authority or any other Tribunal(s)
I verify that the contents of the above sections are true to my personal knowledge and belief and I have not suppressed any material fact(s)