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Grievance Redress Form

Organisation Name:
 Name
 Gender
Complainant Category
 Do You want a Password for this Grievance?
 Password
 Confirm Password
Passwords do not match
 Password Clue

Address of Correspondence

 Address


 Pincode
Country
State
 District
Phone Number
 Mobile
Email

Complaint Details

 NFSA Related?
 Problem relating to:
 Ration Card No.
 FPS Name
 FPS ID / License No.
 FPS District
 FPS Village / Locality
 Card Type

 Grievance Description

Remedial Action(optional):
Upload Relevant Document (Optional):

All documents are to be merged in one document

 Have you earlier lodged the grievance to the above Department on the same subject?
 Reference No
Security Code