DIRECTORATE OF PUBLIC GRIEVANCES

*Date of cause of grievance (DD/MM/YYYY)
(Provide the date on which issue/matter/complaint arose.)

*Have you approached the authority concerned ?
(It is advised to contact the office concerned before approaching DPG for redress of grievance.)

YesNo

*Authority Approached:
*Date:(DD/MM/YYYY)

*What was the Response to your grievance ?	No ResponsePartially ResolvedRejected

*Have you approached any Court/Tribunal/Any Quasi Judicial
Body for this grievance ?

YesNo

*Please enter the grievance description ( Maximum of 4000 characters allowed)

Personal Details of Complainant

*Name

*Gender

MaleFemaleOthers

Do you want to have password?

(A Password may be opted for maintaining confidentiality of your
grievance)

(The password must be at least 6 characters and must contain at least six characters including one lower case letter, one upper case letter,one digit & one of the following special characters - #,@,$,% e.g. Fyfjk3$ )

YesNo

Password:
(password must be at least 6 characters)

Confirm Password:
(Re-enter your password for confirmation)

*Address

Pincode

Phone Number
(Note: Though optional,it would facilitate ascertaining information easily)

Mobile number
(Please Enter Country Code & Mobile Number) eg : 919890000000
( Note: Though optional,it would facilitate ascertaining information easily )

* Country

State:

E-mail address
(Note: Though optional,it would facilitate ascertaining information easily )

Enter the image characters as shown above

GRIEVANCE REGISTRATION FORM