File a complaint under Consumer Protection Act, 2019
You will get just one chance to fill the form therefore be sure that you have paid Rs 500 fee by netbanking or googlepay and have the transaction details. Fill-in all the fields with correct information. After submission, you would receive a copy of this form by email with your complaint reference number. You can send this email print as cover letter with your complaint documents by courier. There is an option to upload your documents at S No 17 in this form. So, prepare your file upload below 5 MB in pdf, doc or docx format beforehand to upload here, if you do not want to send documents by courier. You can get the bank details from payment@icrpc.org in order to pay Rs 500 fee to ICRPC. DO NOT SUBMIT THIS APPLICATION FORM WITHOUT CORRECT DETAILS OF PAYMENT OF RS 500 FEE PAID TO ICRPC, ELSE YOUR COMPLAINT WOULD BE REJECTED AFTER SUBMISSION AND YOU WOULD LOSE YOUR SINGLE CHANCE TO FILL THE FORM.
1. Netbanking Transaction Number for Rs 500 fee paid to ICRPC (Arun Saxena)
*
Get netbanking details from payment@icrpc.org
2. You paid Rs 500 fee to ICRPC (Arun Saxena) through which bank?
*
After paying Rs 500 to ICRPC, write the bank name here
3. Netbanking Transaction date for Rs 500 fee paid to ICRPC (Arun Saxena)
*
-
Day
-
Month
Year
After paying Rs 500 to ICRPC write the transaction number here
4. Complainant's Name
*
First Name
Last Name
5. Complainant's City
*
Your city of residence
6. Complainant's Email
*
example@example.com
7. Complainant's Cell Number
*
10 digit mobile phone number
8. Complainant's Full Address
*
Address line 1
Address Line 2
City
State
Pin Code
9. Opposite Party's (company's) Name
10. Opposite Party's (Company's) Registered Office address
*
Address Line 1
Address Line 2
City
State
Pin Code
11. Email of the Registered Office of the Opposite Party
*
example@example.com
12. Phone number of the Opposite Party at Registered Office
*
Example: 022-12345678 or 1234567890 (for landline or cell)
13. Address of dealer / service center with whom you dealt in your city (if any)
Address Line 1
Address Line 2
City
State
Pin Code
14. Email of dealer / service center (if any)
example@example.com
15. Phone number of the dealer / service center
Example: 022-12345678 or 1234567890 (for landline or cell)
16. Write your complaint date wise summary
*
You can even upload your detailed complaint as an attached file (see S No 17)
17. Upload files (max 5 MB) in doc, docx format (saved in MS word)
Browse files on your computer
You can also send all the documents by courier with your complaint
Cancel
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Submit Your Complaint
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