Guidelines to fill up the Complaint Registration form
The Fields with (*) are mandatory, please select / fill the appropriate inputs.
Details of the Complainant (Your Details)
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1 Name Mention Your Complete Name. *
2 Address

Mention Complete address for Correspondence.

*
3 State Select name of your State from the list. *
4 District Select name of your District from the list. *
5 Pin No. PIN CODE of your locality. *
6 Email Mention Your Complete Email ID for Correspondence . *
7 Phone  Mention Your Phone / Mobile Number for Correspondence *
8 Sex Select Gender of the Complainant from the list. *
Details of the Victim
9 Whether the complainant is the victim ? If you select the yes option then all the fields from S.no 10 to 17 will be filled automatically with same details of the Complainant.
10 Name Mention Complete Name of the Victim. *
11 Address

Mention Complete address of the Victim for Correspondence.

*
12 State Select name of the State of the Victim from the list. *
13 District Select name of the District of the Victim from the list. *
14 Pin No. PIN CODE of victim's locality. (If Available)
15 Email Mention Your Victim's Email ID for Correspondence . (If Available)
16 Phone Mention Phone / Mobile Number of the Victim for Correspondence.(If Available)  
17 Sex Select Gender of the Victim from the list. *
18 Date of Birth Mention the Date of birth of the Victim. *
19 Whether Challenged Person Select the disability status of the victim from the list. *
20 Religion Select Religion of the victim the list. *
21 Caste Select Caste of the victim from list. *
Details of the Respondant
22 Name Mention Complete Name of the Respondant. *
23 Address

Mention Complete address for Respondant.

*
24 State Select name of the State of the Respondantfrom the list. *
25 District Select name of the District of the Respondant from the list. *
26 Pin No. PIN CODE of  Respondant's locality. (If Available)
27 Email Mention Your Respondant's Email ID for Correspondence . (If Available)
28 Phone  Mention Phone / Mobile Number of the Respondantfor Correspondence.(If Available)
29 Sex Select Gender of the Respondant from the list. If the number of Respondants are more than one then Select ‘Group’ option. *
Details of Complaint
30 Category of the Complaint Select the Category/Nature of the Complaint from the list. *
31 Sub-category of the Complaint Select the sub category of the Complaint from the list, if shown after selecting Category. *
32 Department of the Complaint (if applicable)  Mention full details of Public Servant/ Authority against whom the complaint is being made.
33 Date of Incident Mention the date of incident.(If Available)
34 Complete details of the incident Mention full details of your Complaint and relief, which is sought against the women rights violation. *
35 Submit By clicking this button your Complaint will be registered and an acknowledgment page will be open. Take the printout of the acknowledgment for future references.