Central Application - Complaint Vigilance

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Raise Complaint - Online Vigilance & Enforcement Form

Personal Information

Name: *

Please enter Name

Gender: *

Male Female Other

DOB: *

Please enter Dob

Age: *

Please enter Age

Address: *

Please enter Address

Pin Code: *

Please enter Pincode Please enter valid Pincode

Phone:

Fax:

Mobile: *

Please enter Mobile Number

Email: *

Please enter Email Address

Licensee Details

District: *

Please select District

License Type: *

Please select License Type

License: *

Please select License

Brief Description: *

Please enter Description

RECORDING OF A COMPLAINT OR INCIDENT

Particulars of accused persons: *

Please enter of Particulars accused persons

Nature of the offence: *

Please enter nature of offence

Source: *

Please select source

Date of Complaint: *

Please enter date of complaint

Place of Occurrence: *

Please enter place of occurance

Name of Plaintiff: *

Please enter name of plaintiff

Address of Plaintiff: *

Please enter address of plaintiff

Contact Number of Plaintiff:

Please enter contact number of plaintiff

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