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COMPLAINT FORM
(Form for complaint under the Consumer Protection Act 1986)
In the complaint case no……………….………………………. ………………………………………………
Before the Hon’ble District Forum…………………..………………………………………………………
or
Before the State Commission………………………………………………………………………………….
or
Before the National Commission…………………………………………………………………..…………
Complaint No……………………………………………of………………………………………..……………..….
In the matter of …………………………………………………………………………………………………....
Name & address of complainant/complainant……………………………………………………....
versus
Name & address of opposite party/parties………………………………………………….
I/we, the above named complainant/complainants respectfully state before the
Hon’ble Forum/Commission the complaint as follows:
It is therefore prayed
(i) That opposite party be directed to refund the amount paid by the
complainant to the tune of Rs……………………………………
(ii) Complainant may please be compensated to the tune of Rs…………………..for
the mental agony and harassment caused to him/her in the due course
(iii) Cost of litigation may also be awarded suitably.
…………………………
Signature of Complainant
Place:.………………..
Date:………………….. (Name of Complainant)
Verification