Name*
Department*
Faculty
Residential Address of the Student
Permanent Address of the Student*
Email*
Mobile No.*
WhatsApp No.
Landline No.
Programme of Study* UGPGM. PhilPh. DDiplomaOther
Class* F.Y.B.ComS.Y.B.ComT.Y.B.ComF.Y.B.A.S.Y.B.A.T.Y.B.A.
Semester IIIIIIIVVVIVIIVIIIIXX
Roll No*
PRN No.
P.G. / Ph.D. / M.Phil. Registration No.
Name of the Teacher/s / Officer/s / Staff / Section/s / Department/s against whom the Complaint is to be Lodged*
Add Other Students/ More Students detail, if more no. of Students Applying for Redressal of Grievance
Nature of Grievance/s in which Redressal is Sought WrittenUpload File
List of Supporting Documents
Declaration from the student/s I / We hereby declare that the above information furnished by me/ us is true to the best of my/ our knowledge. In case if it is turned false. I/we am/are personally responsible for the punishment.
Date:
Place:
Signature of the Student’s*