Complaint Of CGRF

APPLICATION TO CONSUMER GRIEVANCES REDRESSAL FORUM

తెలుగు

Distribution Licensee : APEPDCL

Individual

Firm

Company

Name of the Complaint*

Full address of the Complaint*

District *

Mandal *

PinCode *

Phone Number *

E-Mail Id *

Fax No

LT HT REGNO (SCNo or RegNo or 1912)*

Category *

Whether any court case or Tribunal case is pending ?*

Nature of Grievance (Please tick(✔) the relevant box)

When cause of action arose ?*

Any other relevant information

Note : Upload written complaint duly signed by the registered consumer*

Note : Upload other proof of attachments pertaining to registered consumer*

Declaration :

I/We, the Complainant/s herein declare that: the information furnished herein above is true and correct,and I/We have not concealed or Misrepresented any fact stated here in above and the documents submitted with. the subject matter of the present grievance has never been submitted to the forum by me/or by any one of us or by any one of the parties concerned with the subject matter to the best of my/our knowledge. the subject matter of my/our Grievance has not been settled through the forum in any previous proceedings. the subject matter of my/our Grievance has not been decided by any competent authority/court/arbitrator,and is not pending before any such authority/court/arbitrator.

Yours Faithfully

(Signature)

(Complainant's name in block letters) *

NOMINATION

(If the Complaint wants to nominate his representative to appear and make submission on his behalf before the forum,the following declaration should be submitted.)

I/We the above named consumer here by nominate Sri/Smt

Whose address is :

As my/our REPRESENTATIVE in the proceedings and confirm that any statement,acceptance of rejection made by him/her shall be binding on me/us.He/She has signed below in my presence.

APPLICATION TO CONSUMER GRIEVANCES REDRESSAL FORUM

Declaration :

Yours Faithfully

(Signature)

NOMINATION

ACCEPTED

(Signature of Representative)

(Signature of Complainant)