जिला लोक शिकायत केंद्र

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Grievance Registration Form

Complainant Information

Mobile Number*

Alternate Mobile Number

First Name*

Middle Name

Last Name*

Father’s/Husband/Mother’s Name

Email ID

Gender*

Aadhar Number

District*

Occupation

Area*

Municipality*

Block*

Panchayat*

Village*

Ward*

Land Mark / Tolla

Police Station

Vidhan Sabha

Lok Sabha

If same as complainant location, click on Yes

Area*

Municipality*

Block*

Panchayat*

Village*

Ward*

Land Mark / Tolla

Grievance Description* max-1000 words

Evidence/Supporting Document*