PB-PGRAMS -:- Grievance Registration Form

Grievance Registration Form


Entries Prefixed with * are Mandatory!

*	Select Office to which the grievance pertains


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

*	Complainant Category

	Do You want a Password for this Grievance?	Yes No

	Address of correspondence
*	Address


	Pincode
*	Country
*	State / UT
*	District

	Phone No.
	E-Mail Id.
*	Please Enter Specific Details about Your Grievance here (4000 Characters Left)


	Relief/Claim Sought ^(optional)(1000 Characters Left)


	Upload(Relevant Document)	only(.pdf) upto 1MB

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


*	Mobile No.
*	Enter code received on your mobile
*	Enter Security Code as Shown