COMPLAINT FORM (Form for complaint under the Consumer ...

1 Downloaded from eHIMAPURTI Page 1 of 2 COMPLAINT FORM (Form for COMPLAINT under the Consumer Protection Act 1986) In the COMPLAINT case .. Before the Hon ble District or Before the State or Before the National COMPLAINT In the matter of .. Name & address of versus Name & address of opposite 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 (ii) Complainant may please be compensated to the tune of 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 Downloaded from eHIMAPURTI Page 2 of 2 above named complainant do hereby solemnly declare that the particulars stated above are true to the best of my knowledge and belief and nothing has been concealed therein.

2 I further certify that annexure I,II and III appealed to the COMPLAINT are the true copies of original documents. Verified day (a)..Annexure I Signature of Complainant (b)..Annexure II (c)..Annexure III (Name of the complainant/Deponent)