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E-Complaint form against Caste Discrimination
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Important Instructions:
1. We assure you that any information given by you will be kept strictly confidential.
2. You may leave the columns/fields blank for which you don't have any information or you do not want to fill. But the fields with (*) in front of them are compulsory.
3. Once you fill and submit the form, preview of the form will be shown to you with the information you have filled, if you wish you may take the printout of the preview page for your record.
4. In case of fake complaints displinary action will be taken by the authorities.
5. This Page Works Best in Internet Explorer !
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| Date of Complaint |
11-August-2020 |
| 1. Personal Details |
| You Are (*) |
Student
Employee
Research Scholar
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| Your Name (*) |
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| Select Your Campus(*) |
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| Your Branch / Department (*) |
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- |
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- |
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| Contact No. (*) |
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| Email ID |
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| 2. Perpetrator Details (Details of the person who has or is inflicting discrimination on you) : |
| Name (*) |
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| Branch / Department (*) |
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| He is (*) |
Student
Employee
Research Scholar
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- |
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| Contact No . |
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| Email ID |
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| 3. Please indicate if you have discussed the matter with someone in the university or at your campus |
| Name |
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| Designation |
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| Branch / Department |
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| Contact No. |
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| Did he/she/they take any necessary action |
Yes
No
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| 4. Witness Details |
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If You have any witness, to add witness details. |
| 5. Describe Grievance |
| Please write description of the incident (*) |
NOTE : Kindly mention date, time and place of incident along with other details.
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| 7. Do you have any proofs? |
Are there any documents or emails etc. which contain information supporting the
occurance described above |
No proofs available
Recording
SMS
MMS
Written material
Physical Evidence
Others
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| Enter the Security Key shown in figure (Case Sensitive)
DlJm |
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