DISTRICT CONSUMER DISPUTE REDRESSAL FORUM: RANCHI

To,

The President

District Forum, Ranchi

 

1)     Name and Address of the complainant:

2)     Name and Address of the Opposite Party:

3)     Details of Goods/Service for which the complaint petition is being filed:

        4) Synopsis of complaint:

        5) Value of Goods/Services:

        6) Date of cause of Action:

        7) Details of Cash Memo/Receipt etc. (if any):

        8) Evidence / Witness in Favour of the Complaint:

        9) Attempt made for settlement:

     10) Claimed Value:

                    (i) Principal Amount:

                   (ii) Compensation, if any:

                  (iii) Cost of litigation, if any:

 
     11) Prayer:

     12) Whether any case is pending in any other court, in this regard:
 

     13) Court Fee Details:

          D.D./P.O. No  : …………………………

          Date                : ………………………....

          Amount           : …………………………

                                                                                       ....................................................................... 
                                                                                                   Signature of Complainant