e-Abhijoga :- Grievance Registration Form

Grievance Registration Form


Entries Prefixed with * are Mandatory!

*	Select Department to which the grievance pertains


	Have you earlier lodged the grievance to the above Department on the same subject ?	Yes No


*	Name
*	Gender	MaleFemaleOthers(If not an Individual)Transgender

*	Complainant Category

	Do You want a Password for this Grievance?	Yes No

	Address of correspondence
*	At
*	Post
*	Block
	Pincode
*	Country
*	State / UT
*	District

	Phone No.	Mobile No.
	E-Mail Id.(Advisable to provide email-id to get status updates)
	Identity proof
	Identity Proof Number/Detail
*	Please Enter Specific Details about Your Grievance here (4000 Characters Left)


	Remedial Action^(optional)(1000 Characters Left)


	Upload(Relevant Document)	only(.pdf) upto 2MB

*	Enter Security Code as Shown